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BOOKS 



ANNA M. GALBRAITH, M.D, 



Four Epochs of Woman's Life 

i2mo of 296 pages. 

Third Edition. 



Personal Hygiene and Physical 
Training for Women 

1 2 mo ot 393 pages, illustrated. 
Cloth, $2.25 net. Second Edition. 



THE 

FOUR EPOCHS 



OF 



WOMAN'S LIFE 

A Study in Hygiene 



BY 

ANNA JVL GALBRAITH, MJD, 

Author of "Personal Hygiene and Physical Training for Women **% 

Fellow of the New York Academy of Medicine; Ex-President 

of the Alumnae Association, Woman's Medical College 

of Pennsylvania? former Attending Physician, 

Neurological Department, New York 

Orthopedic Hospital and Dispensary. 



WITH AN 

INTRODUCTORY NOTE 

BY 
JOHN H. MUSSER, MJX 

Late Professor of Clinical Medicine, University of Pennsylvania. 



THIRD EDITION, REVISED AND ENLARGED 



PHILADELPHIA AND LONDON 

W, B, SAUNDERS COMPANY 

1917 



■flfc^ 






Copyright, 1901/by W. B. Saunders and Company. Revised, reprinted, 

and recopyrighted August, igo3. Reprinted October, 1904, 

January, 1907, January, 191 1, April, 1913, and 

February, 1915. Revised, reprinted, 

and recopyrighted February, 

1917. 



Copyright, 1917, by W. B. Saunders and Company. 




MAR -9 1917 



PRINTED IN AMERICA 



PRE88 OF 

W. B. 8AUNDER8 COMPANY 

PHILADELPHIA 



©CI. A 4 57366 



i 

5f» 



As in a building 

Stone rests on stone, and wanting the foundation 

All would be wanting, so in human life 

Each action rests on the foregoing event 

That made it possible, but is forgotten 

And buried in the earth. ' * 

— Longfellow. 



INTRODUCTORY NOTE 



It has been well said that the bulwarks of a nation 
are the mothers. Any contribution to the physical, 
and hence the mental, perfection of woman should be 
welcomed alike by her own sex, by the thoughtful citi- 
zen, by the political economist, and by the hygienist. 
Observation of the truths, expressed in a modest, 
pleasing, and conclusive manner, in the essay of Dr. 
Galbraith contribute to this end. These truths should 
be known by every woman, and I gladly commend the 
essay to their thoughtful consideration. 

John H. Musser, M.D., 

Late Professor of Clinical Medicine 

in the University of Pennsylvania. 



PREFACE TO THE THIRD EDITION. 



When "The Four Epochs of Woman's Life" was 
written fifteen years ago it was a pioneer work on 
Sex Hygiene; since that time educators have taken 
a great step in advance in urging that in order to 
maintain good health, which must always be based 
on good morals, the teaching of sex education should 
be begun in childhood and graded according to the 
child's age, just as all other studies are. With a 
greater knowledge of heredity and the ever-increasing 
burden on the state of degenerates, whether simply 
feeble-minded or criminal, eugenic marriage laws are 
being strongly advocated; it being the undeniable right 
of the child to be well born. 

And so to the present edition have been added 
chapters on Eugenics and Sex Education, and under 
the Hygiene of Puberty has been included the Safe- 
guarding Maidenhood; and attention is called to the 
frequency of pelvic disorders among young women, 
due doubtless to the present mode of insufficient 
clothing and lack of systematic exercise. 

Other revisions have been made bringing the work 
up to date; and the one in regard to the care of new- 
born infants will be helpful to all young mothers. 

Anna M. Galbraith. 

New York City. 
February, igiy. 



PREFACE. 



"Ignorance is the curse of God; 
Knowledge, the wings wherewith we Hy to heaven." 

—"Henry VI" 

Perfect health is essential to perfect happiness. 
The greater the knowledge of the laws of nature, and 
the more closely these laws are lived up to, so much 
nearer " ideal " will be the health and happiness of 
the individual. Hence the necessity that these same 
laws should be as familiar to the adult man and 
woman as the alphabet. Further, with our present 
knowledge of the certain suffering, disease, and death 
that are bred by ignorance of all these subjects, it is 
litttle less than criminal to allow girls to reach the 
age of puberty without the slightest knowledge of 
the menstrual function ; young women to be married 
in total ignorance of the ethics of married life ; women 
to become mothers without any conception of the 
duties of motherhood; other women, as the time ap- 
proaches, to live in dread apprehension of " the change 
of life;" and many women unnecessarily to succumb 
to disease at this time. 

The masses of women have at last awakened to a 
sense of the awful penalties which they have paid for 
their ignorance of all those laws of nature which 

9 



IO Preface. 

govern their physical being, and to feel keenly the 
necessity for instruction at least in the fundamental 
principles which underlie the various epochs of their 
lives; and it is in response to a widespread demand 
that this small volume has been written. 

This is preeminently the day of preventive medi- 
cine ; and the physician who can prevent the origin of 
disease is a greater benefactor than the one who can 
lessen the mortality or suffering after the disease has 
occurred. 

Anna M. Galbraith. 

IS West Ninety-first Street, New York. 



CONTENTS. 



INTRODUCTION, 

EDUCATION AS THE CONTROLLING FACTOR IN 
THE PHYSICAL LIFE OF WOMAN. 

PAGE 

Huxley's Definition of Education; the Correlation of Mind 
and Body; the Emotional Nature; Age for Going to 
School; the Effect of the Study of the Scientific 
Branches; Industrial Education 17-25 



PART I.— EUGENICS. 

CHAPTER I. 

EUGENICS. 

Eugenics Defined; Contraindications to Parenthood; State 
Control of Defectives and Degenerates; Heredity; 
Galton's Law of Inheritance; Sexual Efficiency; Re- 
productive Factors in the Male; in the Female; 
Character Units; Growth and Reproduction; the 
Limitation of Offspring; Eugenic Medical Examina- 
tions; Eugenic Marriages 26-44 

CHAPTER n. 

SEX EDUCATION. 

Health and Sex Hygiene; The Value of Sound Knowledge; 
Biology of Sex; Special Abuses of Sex in Men; Venereal 
Diseases; Single Standard of Morals; The Periods of 
the Child's Life in Relation to Sex Instruction; Marriage 

and Parenthood 45~66 

II 



1 2 Contents. 

PART II.— MAIDENHOOD. 

CHAPTER III. 
PUBERTY. 

PAGE 

Sexual Development; Age of Puberty; Physical Changes at 
Puberty; First Onset of Menstruation; Psychic Changes 
at Puberty; Safeguarding Maidenhood 67-74 

CHAPTER IV. 

HYGIENE OF PUBERTY. 

Home Life; Corsets; Girdles; Shoes; Underwear; Nutrition- 
Diet; Water; Constipation; School Life; Spinal Curva- 
tures; Exercise; Walking; Running 75-88 

CHAPTER V. 

ANATOMY OF THE "FEMALE GENERATIVE 
ORGANS. 

The Vulva; the Hymen; Condition of the Hymen as a "Proof 
of Virginity; the Bladder; Vagina; Uterus; Respiratory 
Movements of the Uterus; Fallopian Tubes; Ovaries. . 89-95 

CHAPTER VI. 

PHYSIOLOGY OF THE FEMALE GENERATIVE 
ORGANS. 

Ovulation; Etiology of Menstruation; Uterine Nerve- 
supply; the Function of the Uterus; Stages of the 
Menstrual Cycle; Average Duration of the Menstrual 
Flow; Character of the Flow; Relation of Ovulation to 
Menstruation; the Menstrual Wave; Definition of 
Menstruation; Premonitory Symptoms of the Flow; 
Hygiene of Menstruation 96-108 



Contents. J 3 

CHAPTER VII. 
THE ANOMALIES OF MENSTRUATION. 

PAGE 

Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenor- 
rhea; Leucorrhea; Pruritus Vulvae; Frequency of Pelvic 
Disorders in Young Women 109-116 

CHAPTER VIII. 

THE MARRIAGE QUESTION. 

Herbert Spencer's Definition of Love; What Constitutes a 
Suitable Husband; Best Age for Marriage; Shall Cousins 
Marry? Contraindications to Marriage; Do Reformed 
Profligates Make Good Husbands? the Proper Length 
of Time for the Engagement; the Right Time of the 
Year to Marry; the Selection of the Wedding Day. ... 11 7-1 26 



PART III.— MARRIAGE. 

CHAPTER IX. 
THE ETHICS OF MARRIED LIFE. 

The Wedding Journey; the Ethics of Married Life; Shall 
Husband and Wife Occupy the Same Bed? the Con- 
summation of Marriage; the Marital Relation; Times 
when Marital Relations Should be Suspended 127-137 

CHAPTER X. 
SEXUAL INSTINCT IN WOMEN. 

Sexual Instinct in Women; Excessive Coitus; Causes of 

Sexual Excitability 138-143 

CHAPTER XL 
STERILITY. 

Sterility; the Prevention of Conception and the Limitation 
of Offspring; the Crime of Abortion; Infidelity in 
Women i44~i57 



1 4 Contents. 

PART IV.— MATERNITY. 

CHAPTER XII. 
PREGNANCY. 

PAGE 

Nature of Conception; Pregnancy Denned; Duration of 
Pregnancy; the Signs of Pregnancy; Quickening; the 
Determination of Sex at Will; the Influence of the Male 
Sexual Element on the Female Organism; Heredity; 
Hygiene of Pregnancy; Causes of Miscarriage 158-179 

CHAPTER XIII. 

THE CONFINEMENT. 

Preparation for the Confinement; Signs of Approaching 
Labor; Symptoms of Actual Labor; The Confinement- 
bed: the Process of Labor 180-195 

CHAPTER XIV. 

THE LYING-IN. 

Management of the Lying-in; Lactation; Nursing 196-205 

CHAPTER XV. 

THE NEW BORN INFANT. 

Method of Ligation and Dressing of the Cord; the Infant's 
Toilet; the Meconium; the Baby's Bath; the Crib; 
Feeding of Infants; the Scales and the Thermometer; 
Artificial Feeding; the Wet-nurse; Characteristics of 
Healthy Infants; the Stools; Constipation; Urination; 
Dentition 206-233 



PART V.— THE MENOPAUSE. 

CHAPTER XVI. 

THE MENOPAUSE. 

Average Duration of the Menstrual Function; Duration of 
Menopause; the Menopause; General Phenomena of 
the Menopause; Prominent Symptoms of Menopause; 



Contents. 1 5 

PAGE 

Pathologic Conditions of Menopause; Hemorrhage at 
the Menopause a Significant Symptom of Cancer; 
Causes of Suffering at Menopause 234-261 

CHAPTER XVII. 

HYGIENE OF THE MENOPAUSE. 

Diet; Constipation; Stimulants; the Kidneys; Skin; Turkish 
Baths; Massage; Exercise; Profuse Menstruation; Hem- 
orrhage; Mental Therapeutics 262-268 

CHAPTER XVIII. 
HINTS FOR HOME TREATMENT. 

Indigestion; Constipation; Enemas; Diarrhea; Vaginal 

Douche; Baths; Headache; Fainting; Hemorrhage... 269-282 



GLOSSARY 283-288 

INDEX 289-296 



INTRODUCTION. 



EDUCATION AS THE CONTROLLING 

FACTOR IN THE PHYSICAL LIFE 

OF WOMAN- 

Huxley's Definition of Education; the Correlation 
of Mind and Body; the Emotional Nature; Age 
for Going to School; the Effect of the Study of 
the Scientific Branches; Industrial Education. 

"What is man, 
If his chief good, and market of his time, 
Be but to sleep and feed? A beast; no more. 
Sure, He that made us with such large discourse, 
Looking before and after, gave us not 
That capability and godlike reason 
To fust in us unused." 

— "Hamlet." 

The word education is here used in its broadest 
sense, and is meant to include the physical, mental, 
intellectual, and industrial. Huxley's definition is 
as follows : " Education is the instruction of the 
intellect in the laws of nature, under which I in- 
clude not only things and their forces, but men and 
their ways; and the fashioning of their affections 
and of the will into an earnest and living desire to 
move in harmony with these laws. That man, I 
think, has had a liberal education who has been so 

2 if 



1 8 Education. 

trained in his youth that his body is the ready 
servant of his will, and does with ease and pleasure 
all the work that, as a mechanism, it is capable of; 
whose intellect is a clear, cold, logic engine, to be 
turned to any kind of work, to spin the gossamers 
as well as to forge the anchors of the mind ; whose 
mind is stored with the great and fundamental 
truths of nature and the laws of her operations; 
one whose passions are trained to come to heel by 
a vigorous will, the servant of a tender conscience ; 
one who has learned to love all beauty, whether of 
nature or of art, to hate all vileness, and to respect 
others as himself." 

The Correlation of Mind and Body. — It is of the 
utmost importance that the mutual reaction of mind 
and body upon each other should be thoroughly 
understood. This reaction is so constant, so intri- 
cate, and so complex that it is at times difficult to 
say which is cause and which effect. Does the 
depressed state of the mind cause the indigestion, 
or is a torpid liver the real seat of the melancholia ? 

The brain is the most delicately constructed or- 
gan in the entire body. In the lower animals the 
brain is simply the great nerve-center which, with 
its prolongation the spinal cord, presides over all 
the functions of life which differentiate the animal 
from the vegetable. In the human being the brain 
is much more highly developed and complicated; 



Correlation of Mind and Body. 19 

and is, in addition, the seat of the mind, the intellect, 
and the affections. Like all the other tissues of 
the body, the brain receives its nourishment from 
the blood-vessels which pass through it, and its 
healthy maintenance is in a direct ratio to the con- 
dition of its blood-supply. 

A most interesting psychologic study is found in 
the case of cerebral paralysis of young children, 
where there is mental defect amounting to stupidity 
or imbecility, accompanied by extensive paralysis 
of the body, so that the child is not able to sit up. 
With the gradual improvement of the physical con- 
dition, so that the muscles become firm and the 
child can sit, stand, and even walk, there is a cor- 
responding mental development; from being stupid 
and dull, the expression of the face brightens and 
becomes intelligent; the child talks quite as well 
as other children of its age, and sometimes becomes 
really intellectually precocious. Here we see the 
development of the brain as a direct result of the 
improved physical condition. In certain cases of 
insanity, on the contrary, we find that the wasting 
away of the body results from the disease of the 
brain, i. e. } the disease of the brain has wrought 
the wreck of the body. 

From these pathologic studies, or studies of how 
the diseased state of the brain and body may be 
overcome by physical development, on the one hand, 



20 Education. 

and, on the other hand, how the healthy body may 
be wrecked by disease of the brain, we will turn 
to a consideration of the effect of the development 
of the mind and intellect upon the physical health. 

On a girl's entering Vassar College an exact and 
detailed physical examination is made by the resi- 
dent physician, a health record is kept during her 
stay there, and at the time of her graduation a final 
physical examination is made. As a result of these 
statistics Dr. Thelberg says : " These statistics, now 
covering a number of years, show that not only can 
girls profitably take a college education, that is ac- 
complished; but will prove that grave physical im- 
perfections can be corrected in the period between 
eighteen and twenty-two years of age, coincidently 
with the development of the mind along the lines 
of college work; the college work, if not excessive 
in amount, being a real and most important factor 
in the physical development/ ' 

But a still more striking proof can be cited of 
the beneficial result of mental and intellectual oc- 
cupation upon the bodily health. At Vassar a great 
deal of attention is very properly paid to general 
hygiene and the physical development, in addition 
to the natural advantages of outdoor life in the 
country. 

Take, for example, a woman's medical college 
located in the city: the four years' course places 



Correlation of Mind and Body. 21 

the greatest strain on both mind and body; prac- 
tically no time is left for recreation, and very much 
too little time is spent in sleep ; the amount of exer- 
cise taken is the minimum. Yet in spite of all these 
disadvantages under which the young women labor, 
a great many of them who enter far below par in 
health, or, indeed, on the fair road to become chronic 
invalids, graduate very greatly improved in health. 

The Emotional Nature. — Formerly much more 
than now, owing to the defective methods of her 
education and mode of life, the emotional nature of 
woman was allowed to run riot. The child was 
coddled; the girl was allowed to grow up without 
any of the discipline which young men receive in 
their college and business life, and little or no at- 
tention was paid to her physical development. The 
woman naturally became a bundle of nerves, highly 
irritable, unreasonable, and hysterical. All this re- 
acted in the most detrimental manner upon her 
physical health. 

The seed for much of this emotional hyperesthesia 
is sown in childhood. From birth until the end of 
the eighth year should be one grand holiday. Dur- 
ing this time the child develops very rapidly, espe- 
cially during the first two years of life. And at 
the end of the eighth year the brain has attained 
to within a few ounces of its full weight. The 
muscular system has been developed together with 



22 Education. 

the coordination of motion. The child has learned 
to use a language fairly well; she has developed 
an excellent memory and is most inquisitive and ac- 
quisitive. 

Another method for undermining the healthy tone 
of the nervous system is the intricate dances taught 
very young children and then placing them on public 
exhibition, where they are wrought up to the highest 
pitch. From a purely medical standpoint, children 
under eight years of age should not be allowed to 
take dancing lessons. After this age a moderate 
amount of dancing in a well-ventilated room is good 
exercise. 

Children's parties belong in the same category, 
and, on account of the injurious effects on the 
nervous system, should be tabooed. They are too 
exciting, and cause an overstimulation of the nerv- 
ous system and a precocious childhood and puberty. 

Instead of rearing an oversensitive hot - house 
plant that must be fragile in the extreme, strive 
to rear a sturdy plant that can hold its own amid 
the storms. The child should spend as much of 
its life as possible in the open air, and in the warm 
months live out-of-doors. City children should be 
taken to the seashore or country to spend several 
months every summer. Together with outdoor 
sports, gymnastics adapted to the age of the child 
should be begun early and continued throughout 



Correlation of Mind and Body. 23 

life. Good muscular development is attended with 
good digestion and a well-balanced nervous system. 

Until after the twelfth year there should be ab- 
solutely no difference between the physical, mental, 
or industrial education of girls and boys. And, 
still further, they should be encouraged to have their 
sports together ; this will improve the girls physically 
and broaden them mentally, and will do a great 
deal to take the rough edges off the boys. After 
this age it will be wise to allow slight barriers to 
grow up, without calling the attention of any one 
to the fact, that will cause the companionship to 
be less free and unrestrained. 

Age for Going to School.— Although the child 
may be allowed to go to kindergarten long before 
this time, it should not be allowed to enter the 
school-room before eight years of age. And from 
eight to twelve years, not more than four hours 
a day should be spent in study. After this time it 
may be put down more closely to intellectual work ; 
but no more mental work should be required than 
will enable the girl to enter college at eighteen. 
And eighteen years of age is as young as any girl 
should be allowed to go to college; after this age 
the mind is more matured and acquires knowledge 
more easily than before, while the development of 
the body is less rapid. The physical system has 
become more stable. The literature indulged in 



24 Education. 

by girls under eighteen years of age should be most 
carefully selected. 

The Effect of the Study of the Scientific Branches. 

— A knowledge of the laws of nature is essential 
to health; hence the necessity for the study of the 
natural sciences — anatomy, physiology, chemistry, 
physics, and zoology. Aside from the intrinsic value 
of this knowledge, it is almost universally conceded 
that these studies develop the judgment; and no 
one will have the temerity to deny that a lack of 
judgment must undermine the health as well as the 
success and happiness of the individual. 

Industrial Education. — When it is considered 
how intimate are the relations between the physical 
and the psychic states, and how often the psychic 
condition leads to actual disease, and that often of 
the most incurable type, it needs no demonstration 
that a mental occupation which will take the woman 
out of herself is a physical necessity. Therefore 
when the girl has reached the subjective limit of 
her intellectual education, — that is, when she has 
reached the limit of her capacity or taste, — it is 
essential to her physical well-being that she should 
turn her attention to some industrial occupation. 
This may be housekeeping or any other occupation 
for which she has taste or talent. A healthy mental 
occupation is an absolute necessity to prevent the 
individual from becoming self-centered. And to 



Correlation of Mind and Body. 25 

become self-centered is the first step on the certain 
road to chronic invalidism. 

A most important part of an education is the 
knowledge of how to procure the most perfect de- 
velopment of the body possible, and how to maintain 
the health. This has not been touched upon here, 
since it has been very thoroughly covered in "Per- 
sonal Hygiene and Physical Training for Women," 
and the present volume concerns itself only with the 
four critical epochs of woman's life. 

With this broad view of an education, as a means 
to procure the best physique possible; a mind dis- 
ciplined to meet to the greatest advantage all the 
vicissitudes of life; an intellect developed along the 
lines of its greatest possibilities; and an occupation 
chosen in accordance with the tastes and talents of 
the individual; it becomes an incontrovertible fact 
that the education is the controlling factor in the 
physical life of every woman. 

" Be not simply good ; be good for something." 

— Thoreau. 



PART I.-EUGENICS. 



CHAPTER I. 

EUGENICS. 



Eugenics Defined; Contraindications to Parent- 
hood; State Control of Defectives and Degenerates; 
Heredity; Gallon's Law of Inheritance; Sexual 
Efficiency: Reproductive Factors in the Male, in 
the Female; Growth and Reproduction; The Limi- 
tation of Offspring; Eugenic Medical Examina- 
tions; Eugenic Marriages. 

" A man's essential nature is determined by his inheritance." 

There is an increasing disposition for students of 
human affairs to hold that children have a right to 
be well born; to maintain that society should take 
steps to see that those who bring children into the 
world are fit to do so. 

Genetics is the study of the laws of heredity and 
their application in the improvement of the human 
race, animals, and plants. 

Eugenics is a branch of genetics which refers par- 
ticularly to the human race; it is the science of pro- 
ducing better human beings by applying the estab- 

26 



Eugenics. 27 

lished laws of genetics and heredity. On the positive 
side it means selecting desirable people as parents; 
and negatively, preventing propagation by unde- 
sirables. It proposes a better race of men through 
selective mating. 

Eugenics is effective only if it is applied to normal 
stock, and if persons actually make use of its con- 
clusions in selecting marriage mates. The problem 
is, first of all, a personal one; it must involve indi- 
viduals before it can involve the race. It is to spare 
both man and woman from the unhappiness that 
must occur from uncongenial, vicious, or otherwise 
unfit companionship; and from the burden and the 
humiliation of unworthy or even degenerate progeny. 

Viewed from the standpoint of society or of the 
nation, the problem is to mitigate the burden of ineffi- 
ciency, vice or degeneracy, and crime that today 
occasions the chief expense of governments and the 
chief menace to the progress of the race. Repro- 
duction is not an individual right; it is primarily a 
social phenomenon. Human society in the interest 
of its own advancement and soundness has the right 
to deny the privilege of propagation to those who for 
any reason are unfit to reproduce. 

Contraindications to Parenthood. — No child should 
be born into the world save from good stock. By 
"good stock" the eugenist means one relatively free 



28 Eugenics. 

from undesirable unit characters; and the most im- 
portant of these are alcoholism, feeble-mindedness, 
epilepsy, insanity, pauperism, and criminality. All 
of these classes should be excluded from the list of 
those to whom is granted the high privilege of exer- 
cising the highest, holiest, and most important func- 
tion of the race — parenthood. 

Broadly speaking, there are three elements or 
aspects of parental fitness or unfitness to add to the 
population: (i) Physical, mental, and moral dis- 
qualifications which are certainly transmissible 
through heredity; (2) qualities, such as infection 
through venereal diseases and others, which are cap- 
able of being transmitted to the offspring at or be- 
fore birth; and (3) inability, personal or economic, 
to give the children a chance to enter the world's 
activities with a reasonable hope of normal success. 

We know that epilepsy, feeble-mindedness, idiocy, 
insanity, shiftlessness, criminal tendencies, includ- 
ing those toward sexual indulgence, selfishness, lazi- 
ness, and other similar weaknesses of mind and 
morals, are subject to inheritance. Similarly, by 
careful study of statistics, that poor resistance to 
tuberculosis, weak hearts, poor qualities of blood 
and of the internal secretions, and many other weak- 
nesses which serve as the foundation of diseases, are 
clearly transmissible. 



Eugenics. 29 

Alcoholism is a genetic or transmissible factor which 
destroys the normal psychic type and thus breaks up 
family ties; the lowered efficiency of alcoholics tends 
toward pauperism and crime; the lowered resistance 
makes them the victims of infectious diseases, and 
shortens the expectancy of life. Alcoholism is a 
germinal defect; the children of inebriates are very 
liable to nervous weaknesses, epilepsy, imbecility, 
etc. ; and the degeneracy is transmitted in some form 
in 100 per cent, of two alcoholic parents. These 
marriages should be prohibited by law. 

The certainty that feeble-minded parents will 
have feeble-minded children emphasizes the social 
enormity of permitting them to marry. Society 
obviously has the moral right to protect itself not 
only against the multiplication of the burden, but 
also to arrest the course of degenerating germ-plasm 
through succeeding generations. And it is the duty 
not only of parents and friends but also of the state 
to prevent the marriage of all feeble-minded persons. 

Cretinism is a condition in which stunted growth 
is associated with defective mental development; the 
intelligence varies from feeble-mindedness to idiocy. 
Other forms of degeneracy are deaf-mutism, crimi- 
nality, and epilepsy. 

Hemophilia, or "bleeders," is a transmissible char- 
acter unit; as are also hysteria, nervous diseases, and 



30 Eugenics. 

degenerative insanity. To this same type belong 
drug habits, narcotism. 

There seems to be no rational grounds to doubt 
that in certain families organic defects of the heart 
tend to perpetuation through heredity. In our 
present state of knowledge it would be well, from the 
standpoint of the individual and the viewpoint of 
heredity, that the victims of heart disease should 
not marry or, at least, not bear any children. 

Tuberculosis subjects ought not to marry while 
there are any manifestations of the disease present, 
nor for three years following the disappearance of 
these symptoms. 

Unfit individuals who have themselves inherited 
taints such as those above mentioned should not be 
allowed to marry unless it can be shown that their 
marriage will not be likely to result in tainted off- 
spring. If there is a probability that it will, these 
defectives should either be segregated under the 
care of the state during the reproductive period, or 
by sterilization be prevented from procreation. 
State laws permitting of the sterilization of insti- 
tutional cases have been passed by a number of state 
legislatures; and there is every reason to believe that 
they will be administered conservatively. 

On the selection of marriage mates made by the 
rising generation depends the quality of the coming 



Eugenics. 31 

generations that will take up the nation's burdens 
at the time those of us who are in middle life are 
dropping them. Society has a right to demand that 
some intelligence should be displayed in these selec- 
tions, which has hitherto been left to blind instinct, 
propinquity, or convenience. 

Heredity. — There is no fact more patent and more 
universally recognized than that children inherit 
physical, mental, and moral traits from their parents. 
If we now couple with this demonstrated fact the 
equally demonstrable fact that the germ-plasm is 
persistent throughout generations, we are forced to 
recognize that the germ-plasm in the individual 
represents in a very important sense the surviving 
characteristics of that individual's ancestors. In 
the transmission of traits the word "surviving" 
implies that something has been lost and something 
has survived. The principle has a biologic founda- 
tion that extends much further back than to the 
remotest historic generation. 

When a character unit of one parent and a like 
character unit from the other parent coexist in the 
germ-plasm of the offspring, they cumulatively 
modify the resulting inherited faculty; or when a 
character unit from one parent and an unlike or 
antagonistic character unit from the other parent 
coexist in the germ-plasm of the offspring, they 



32 Eugenics. 

manifest themselves by the dominance of one and 
the recession of the other, with corresponding modi- 
fications of the resulting inherited faculty. In this 
way human faculties are modified, but not multi- 
plied. 

And so it has been found that traits of strength as 
well as taints are secured through heredity. General 
bodily strength, resistance to disease, mechanical 
ability, memory, cheerfulness, musical, artistic and 
literary ability, and strong moral qualities, such as 
unselfishness, conscientiousness, etc., are capable of 
direct transmission. 

Galton's Law of Inheritance.— (i) The two parents 
between them contribute on the average one-half of 
each inherited faculty, each of them contributing 
one-fourth of it. (2) The four grandparents con- 
tribute between them one-fourth, or each of them 
one-sixteenth. (3) The eight great-grandparents 
contribute one-eighth, or each of them one-sixty- 
fourth, and so on through preceding generations. 

This law of Galton's is one of the most important 
generalizations- that has been offered in human 
breeding, i. e., the germ-cell is the summation of its 
racial antecedents derived in certain more or less 
definite proportions from each member of the pre- 
ceding ancestral generations. 

The fundamental conception underlying the science 



Eugenics. 33 

of eugenics is that life is not only universal but con- 
tinuous from generation to generation. And this 
continuity of human life, its perpetuation from 
generation to generation, is effected through the 
germ-plasm which exists as the same germ-plasm in 
parents and offspring, and which exists with, but 
which is different from, the body-plasm. 

And this germ-plasm which is continuous from 
generation to generation is the medium not only for 
the perpetuation of the mere attributes of organic 
life, but the attributes of the race and of the indi- 
vidual. Thus the parent becomes, as it were, "the 
trustee of the germ-plasm," but not the producer of 
offspring. Heredity is essentially, then, a matter of 
continuity between succeeding generations of living 
organisms. 

The germ-cell is so freighted with ancestral poten- 
tialities as to make the previous history of its germ- 
plasm through the preceding generations a matter of 
deep concern to the conscientious prospective parent. 
Together with this must be coupled the principle of 
the average equal importance of parents in their 
hereditary influence upon progeny. The practical 
point is, that in prospective marriages every effort 
should be made to determine the quality of the 
germ-plasm, not only as detenriined by its more or 
less masked manifestations in the parties to the pro- 
3 



34 Eugenics. 

posed union, but also by its more completely re- 
vealed manifestations in parents or grandparents on 
both sides. 

Sexual Efficiency. — The continuity of life from one 
generation to another depends upon the union and 
blending of germinal elements derived from both 
sexes. To effect the union of these germinal elements 
is the function of sex; and it is of the utmost im- 
portance that they be brought into contact with 
each other under the most favorable conditions. 

The germ-plasm lies dormant in the individual 
during the earlier and more active period of growth, 
and becomes inactive or atrophied and disappears 
with the changes incident to old age. When a certain 
stage of growth, known in the male as "adolescence" 
and in the female as "puberty," has been reached, 
the germ-plasm becomes active. 

Reproductive Factors in the Male. — The germ-cell 
thus formed in the male is a microscopic organism 
consisting of a head and a tadpole-like tail, and 
possesses the power of spontaneous movement. 
This generative unit is known as the spermatozoon, 
and is derived from the germ-plasm which is located 
in the testes, and which, when combined with certain 
mucous secretions, comprises what is known as the 
semen. The testes (two in number) are oval glands, 
varying from 2 to 3? inches in greater diameter, and 



Eugenics. 35 

are pendulous bodies in a loose sac, called the scrotum. 
The spermatozoa form in great numbers in the inte- 
rior of the testes, especially during sexual excitement, 
and are discharged through a series of long tortuous 
ducts. To effect the fertilization of an ovule under 
normal conditions the spermatozoa should be de- 
posited in the vagina, whence, by means of their own 
powers of migration, they reach and fertilize the 
ovary in the interior of the uterus. 

Reproductive Factors in the Female. — The generative 
unit in the female is known as the ovule or egg and 
is of microscopic dimensions. The germ-plasm from 
which this generative unit is derived is located in the 
ovaries and is active or capable of producing ovules 
from about the age of fourteen to forty-five, when 
the menopause is experienced. The ovaries are two 
in number, and are glands about i inch long, situated 
on either side of the uterus. The ovule or egg forms 
in the interior of the ovary and matures within a 
sac or follicle, known as the Graafian follicle, which 
in the process of maturing migrates to the surface of 
the ovary and ruptures. The ovule thus liberated 
perishes unless it is picked up by the floating fringes 
of the trumpet-shaped end of the Fallopian tube, 
through which it passes into the uterus. In cases in 
which pregnancy occurs a single ovule and a single 
spermatozoon come in contact within the uterus, 



36 Eugenics. 

when fertilization or impregnation takes place. 
As soon as fertilization takes place the ovule is 
called an ovum, grows fast to the wall of the uterus, 
and so the growth of the new offspring, or fetus, 
begins. The fetus is thus nourished for about 280 
days, or during the period spoken of as pregnancy, 
after which it is forced by muscular contractions of 
the uterus to descend through the neck of the uterus, 
vagina, and bony pelvis into the world by the process 
known as birth or parturition. 

Character Units. — Life as transmitted in accord- 
ance with these laws just set forth always carries with 
it, first, the general characteristics of the race, and 
second, the special characteristics of the ancestors. 
These special characteristics establish what is known 
as (amily resemblances. Identical reproduction never 
has. occurred and never can, because there are always 
two parents, and, as a rule, each parent has equal 
power to transmit its characteristics to the offspring. 

In forms that reproduce sexually there occurs a 
differentiation of the body substance into what 
Weismann terms somatoptasm and germ-plasm. The 
somatoplasm includes the body tissues, that is, the 
bulk of the individual, which is fated in the course of 
events to complete a life cycle and then die. The 
germ-plasm, on the contrary, is the immortal frag- 
ment freighted with the power to duplicate, the whole 



Eugenics. 37 

organism, and which, barring accident, is destined to 
live on and give rise to new individuals. 

The germ-plasm thus carries potencies for de- 
velopment of both germ-plasm and somatoplasm, 
while, according to this conception, the somatoplasm 
has only the power to reproduce its own kind. How- 
ever, the germ-plasm is not formed afresh in each 
generation, neither does it arise anew when the 
individual reaches sexual maturity, but it is a con- 
tinuous substance present from the beginning. 

Growth and Reproduction. — There is a certain de- 
gree of antagonism between the nutritive and repro- 
ductive functions, the one being executed at the ex- 
pense of the other. The reproductive apparatus de- 
rives the material of its operations through the nutri- 
tive system upon which it is entirely dependent for 
the continuance of its function. When, therefore, 
the reproductive apparatus is in a state of excessive 
activity it will necessarily draw off from the indi- 
vidual some portion of the elements destined for the 
individual maintenance. It may be universally 
observed that when the nutritive functions are par- 
ticularly active in supporting or developing the indi- 
vidual the reproductive system is in a corresponding 
degree undeveloped. 

The first factor in sexual efficiency and, therefore, 
the first factor in eugenics is the necessary maturity 



38 Eugenics. 

of both parties to the reproductive act. It may be 
seen that there is a sharp distinction between repro- 
ductive capacity and reproductive efficiency; the 
first is reached at puberty in the female and adoles- 
cence in the male; while the latter is not attained 
until years after, when the body has attained its 
maximum growth and when its still accumulating 
energies can be more exclusively devoted to repro- 
duction; so that early marriages are damaging both 
to parents and to their offspring. 

By early marriages are meant those which are 
contracted at or near the time that the individual 
attains full stature; the next few years after this will 
be taken by nature for maturing the organism. 

The Limitation of Offspring. — The relationship 
between the germ-plasm and the body is mainly 
nutritive. If the body is well nourished the germ- 
plasm, under normal conditions, is correspondingly 
well nourished. It is notably true that children 
born under conditions of impaired maternal nutri- 
tion are less resistant and consequently less liable to 
survive the periods of infancy and childhood than 
those born of well-conditioned mothers. 

Further, Mr. Spencer has shown that in the phe- 
nomena of reproduction, taken in all of its bearings, 
the energy available for reproductive purposes is the 
residual energy after the expenditure for the other 



Eugenics. 39 

functions or industrial activities. The overworked 
and underfed family is generally either a family of 
low fecundity or the offspring will tend to unfitness. 
The fitness or unfitness of an individual, all other 
conditions, such as education and environment, being 
equal, is determined entirely by the laws of heredity. 

And just here is the beginning of ethics. What 
right have we, with this law, with the law of cause 
and effect, with the laws of human breeding, with 
the laws of heredity to guide us, what right have we 
to bring into this world a progeny unfit for the 
struggle? What moral right have we to impose ex- 
istence upon offspring, when by virtue of these laws 
we know in advance that in the unequal conflict for 
existence such offspring is foredoomed to pain, 
misery, and abnormal death? 

If we allow ourselves to follow our primitive im- 
pulses, untempered and unguided by intelligence 
with which we are surrounded, we make ourselves 
responsible for sending such strains of degeneracy 
down through succeeding generations. The unfit 
must be kept from keeping up and multiplying the 
many poisoned currents of hereditary deficiency by 
statutory limitations of marriage among certain de- 
fectives; by the actual sterilization of certain limited 
classes, and, above all, by education and the exercise 
of intelligent, voluntary selection; the utilization of 



40 Eugenics. 

knowledge and reason to repress mere impulse and to 
give intelligent direction to ineffaceable instinct. 

Eugenic Medical Examinations. — The necessity for 
these examinations applies with equal force to both 
sexes. The state should require certificates not only 
of complete freedom from venereal diseases and de- 
generative defects from all applicants for marriage, 
but also a certain grade of physical efficiency. To 
be of value these physical examinations should be 
based on a standardized percentage table for physical 
efficiency such as that recommended for women in 
"Personal Hygiene and Physical Training for Women" 
{Second Edition), pages 328-333, and the candidates 
classified accordingly. These papers would then be 
filed and become the property of the state. This 
board of medical examiners could perhaps be made 
a branch of the state board of health, and should 
consist of both men and women physicians especially 
trained for that work. 

A woman examiner will learn much concerning 
women that would be concealed from men; then, too, 
since these examinations must include a pelvic ex- 
amination (it having been shown by statistics that 
66 per cent, of young women suffer from some form 
of pelvic trouble), there is no excuse for subjecting 
young women to such examinations made by men. 
Finally, there is very much that these young women 



Eugenics. 41 

want to know and very much need to know that they 
would ask only of a member of their own sex. 

These eugenic records, placed on file, would in 
time come to have very great value, because they 
would cover the history of successive generations 
and would materially add to the family pride not 
only in keeping the stock pure, but in improving it. 
And in case of contemplated marriage they could be 
referred to just as in investigating the title to property. 
The question would then come to be not what is a 
young man (or woman) worth, not what is his social 
position, but what kind of a man is he physically, 
morally, and mentally, and what kind of a eugenic 
record has his family. 

Eugenic marriages would then come to signify 
the union of one man with one woman as husband 
and wife, not merely for the perpetuation of the 
species without reference to quality, but for the pro- 
duction of the best possible progeny. 

In the second place, in order to get the best results 
of offspring there are certain principles of selective 
mating which should be respected. Individuals who 
under proper conditions might marry and produce 
sound offspring with one mate, may not do so with 
another. We now know enough of heredity to say 
that some individuals ought not to be allowed to 
reproduce at all. 



42 Eugenics. 

Until the states all pass such laws the church can 
do much to help in the education of the masses by 
following the example of Dean Sumner, of Chicago, 
who has declared that no marriage will be solemnized 
in his church unless both parties show medical certi- 
fication that they are fit for parenthood. It will 
eventually come to pass that every wise man and 
woman will want to have a rigid medical examination 
once every year to ascertain whether they are sound 
or not. 

Eugenic Marriages. — It is evident that as long as 
the institution of marriage remains in human society 
the stream of life must flow through this institution. 
Practically, therefore, the eugenic movement aims 
at the control of the institution in the interest of im- 
proving the racial qualities of future generations, 
that is, in securing wise marriages in society from the 
standpoint of biology. The stream of life can be 
polluted in two ways, either at its source or along its 
course. The eugenic program is to improve the race 
by inducing young people to make a more reasonable 
selection of marriage mates — to fall in love intelli- 
gently. To this end young men and young women 
must at a very early age be given right ideals of 
marriage and parenthood, with different standards 
of selection from what most of them have today. 
The ideals of good manners, social position, good 



Eugenics. 43 

looks, and wealth must be replaced by ideals of good 
health, intellectual ability, and moral character. 
There must be an education for parenthood not only 
in the matter of rearing the young, but also instruc- 
tion of the proper sort along the lines of heredity, 
sex morality, and the social importance of the 
family. 

The more or less instinctive selection in marriage, 
now too much in vogue, should yield to a more intelli- 
gent choice of mates for the perpetuation of the 
human family. The haHowed sentiment of love 
would then be based upon human experience. The 
appeal to love should be broader and deeper, so that 
it would seek those higher qualities which have been 
bred into the individual, rather than mere surface 
appearances. Love should embrace a consideration 
of the welfare and happiness of the unborn. 

Everyone knows how powerful are the bonds of 
affection between a young man and a young woman 
who have fallen in love, and how little influence the 
advice or protests of relatives and friends often has 
on the outcome. Nevertheless young people differ 
very greatly in their control over romantic love, and 
there is usually a long interval between the first 
acquaintance and the betrothal. And instead of first 
considering wealth or social position, upon which so 
many marriages of today are based, it should be, 



44 Eugenics. 

above all, a consideration of the consequences to the 
offspring. 

The application of eugenic principles must apply 
primarily to the fitness or unfitness of the individual 
to marry anybody, and secondarily to the fitness or 
unfitness of two persons to marry each other. Thus 
no person would require advice against marrying a 
confirmed epileptic, a cretin, a feeble-minded or insane 
person. Nor would anyone wittingly marry the vic- 
tim of a communicable disease, such as gonorrhea or 
syphilis, the existence of which may, however, be 
concealed. 

In some way or other the duty to marry and to 
produce larger families must be brought home to our 
eugenic stock. Young men to deserve to marry well 
must lead clean, wholesome lives; and the young 
women must be willing to make reasonable sacrifices. 
This ideal of the duty of those who have inherited 
the best qualities to perpetuate the race needs to be 
impressed especially upon our young college graduates, 
both men and women, as well as the professional and 
scientific classes. At the present time they seem to 
fear that early marriage might interfere with their 
ambitions, and so either do not marry at all or only 
late in life. Whereas, were these marriages made in 
youth, success would be even more certain because 
wiser and saner lives would be lived. 



CHAPTER II. 

SEX EDUCATION- 

Health and Sex Hygiene; The Value of Sound 
Knowledge; Biology of Sex; Special Abuses of 
Sex in Men; Venereal Diseases; Single Standard 
of Morals; The Periods of the Child's Life in Rela- 
tion to Sex Instruction; Marriage and Parenthood. 

Health and Sex Hygiene. — At the present day the 
ideals of health have entered the social consciousness 
as never before — that health is essential not only for 
well-being, but for efficiency. The trend of modern 
education is in the direction of training the body as 
well as the intellect. This comes from the recogni- 
tion of the fact that mental efficiency is largely de- 
pendent upon bodily health. 

All educators agree that a knowledge of hygiene is 
of the greatest importance; and a knowledge of the 
hygiene of the sex functions is from a biologic and 
ethical point of view absolutely essential for good 
health and good morals. The vast amount of dis- 
ease and suffering in the present generation is to a 
large extent due to the gross ignorance which has 
been allowed to prevail in the past. 

45 



46 Eugenics. 

Twenty years ago personal sex hygiene was recog- 
nized as the chief reason for sex education; social 
diseases began to attract public attention ten years 
ago; commercialized prostitution has been espe- 
cially prominent in the discussions of the past five 
years; and recently there has been emphasis on sex 
education with reference to eugenics. 

A fact of universal experience cannot be too 
strongly impressed upon parents, that if they do not 
teach their children what is right, others will teach 
them what is wrong. 

It is important that the child's first idea of genera- 
tion and birth should be associated with his mother's 
relation with him as the source of his life. It is im- 
portant not to say too much. He should not be told 
everything there is to know, only what a healthy 
curiosity demands. The child does not seek for de- 
tails; the wonderful, surprising fact that he is born 
from his mother's body fills up the measure of his 
curiosity. At a later period, certainly before the 
child is exposed to the associations of school life, the 
father and mother should both warn him against bad 
companions and bad talk. 

The problem of physical morality or clean living 
is primarily a problem of self-control, of the mastery 
of the will over the passions. This mastery must be 
founded upon perfect intelligence of the laws of life 



Sex Education. 47 

and sex, and the relation of these laws- to bodily 
health. In order that young men should live accord- 
ing to physiologic laws it is necessary that they should 
know what these laws are, as well as the consequences 
of their violation. Since human beings are left to 
control the most powerful appetite by intelligence, it 
is evident that a policy based on silence, ignorance, 
and mystery must fail. 

The Value of Sound Knowledge. — One of the values 
of sound knowledge is that it displaces half-knowledge, 
which is the very worst sort of ignorance. There 
must be provided a systematic sex education, properly 
graded, which will obviously be different for boys and 
girls. This should be guided by and follow the child's 
curiosity and not precede it; but it should at each 
step precede the actual needs of the child and youth 
in respect to its life and conduct. It will naturally 
take advantage of the fact that the development of 
the child affords psychologic periods for certain parts 
of the instruction; and the fatal mistake must not be 
made that all necessary information can be reserved 
until the child has reached the age of puberty, and 
then given at once. 

The most important reason why sex education 
should not be concentrated in this short period of 
youth is that it is impossible to exert the most desir- 
able influence upon health, attitude, and morals ex- 



48 Eugenics. 

cept by a gradual unfolding of the plan of life corre- 
sponding to the natural developmental periods of the 
child's life, beginning in early childhood and graded 
for each period up to maturity. Most young people 
who in early adolescence receive their first lessons from 
their parents and teachers have already had their 
attitude formed by their playmates. Even their 
morals may have been corrupted and their health 
irreparably injured several years before puberty. 
There are many problems of sex relations to society 
that young people should be led to consider in the 
late teens and early twenties. 

Biology of Sex. — The difference between men and 
women in body, mind, disposition, and temperament 
is the direct result of the development of the sex 
nature of the individual. The biologic place of sex 
is a wonderful, vital, stimulating, and holy endow^- 
ment of human life, to be treasured and invested as 
we treasure bodily health, natural ability, and attrac- 
tive disposition. Only when we grasp the whole 
problem, with the constructive as well as the disas- 
trous possibilities, can we use it as a part of real human 
education. The word "sex" must come to mean fine 
and high things, rather than bestial and low. 

The strong point of the modern view of sex educa- 
tion is that it is badly needed. And to be of value 
this information must be received and assimilated 



Sex Education. 49 

before the critical points appear that make the in- 
formation necessary. For example, it is important 
that the child of either sex should know beforehand 
the real nature and some of the bodily and mental 
changes that take place at puberty. Girls need this 
in order not to be alarmed and to properly protect 
themselves at menstruation; and boys should know- 
that the awkwardness, change of voice, and seminal 
emissions are the perfect natural steps to manhood. 

The strong bond that usually exists between the 
child (whether boy or girl) and its mother, the boy's 
growing admiration for his father, and the chivalrous 
spirit which usually comes to normal boys during the 
late period of adolescence when they begin to admire 
girls, illustrate what is meant. Each critical period 
of individual development furnishes the psychologic 
moment when special appeals should be made. 

The child must know the meaning of sex; he must 
know what are the best standards of the race about 
the use of sex; he must be willing to choose to use it 
in accordance with these standards; and he must have 
the will power which will enable him to carry out his 
choice of conduct. He cannot reasonably be ex- 
pected to attain this disposition in ignorance and 
without expert help. 

It is believed by biologists that the sex organs 
(ovaries and testes) manufacture certain specific 



50 Eugenics. 

substances which on being poured into the blood- 
current pass to the muscles, brain, skin, and other 
organs. These substances by their presence stimu- 
late the particular growth that we have noticed as 
belonging to the various sex organs. In other words, 
the natural healthy condition of the internal sex 
organs, through their direct action on the blood, 
modifies most profoundly the body, mind, and the 
nature of the organism to which they belong. 

These facts have the most far-reaching importance. 
It is well known that the boy changes in important 
ways as soon as he is sexually mature. There is rapid 
growth of the body, the muscles become firmer, the 
vocal chords increase in length, and the voice falls 
from the pitch of a woman's to that of a man, and the 
temperament, mental qualities, and ambitions be- 
come those of a mature man. If, however, the testes 
are removed by operation, these changes do not occur; 
but the man retains the more feminine qualities of 
boyhood. It is then self-evident that in order to 
attain a strong, normal, manly development of body 
and mind, the first essential is the sound, normal de- 
velopment of these internal organs. Conversely, 
anything which interferes with the healthy normal 
development of these internal sex organs will to that 
extent prevent the boy from developing into full 
manhood. The effect of such knowledge as this 



Sex Education. 5 1 

upon the average boy in restraining him from all 
injurious lines of action is obvious. The same gen- 
eral laws hold good for the development of a girl into 
complete womanhood. 

But there is another side of the question which 
cannot be ignored. This is the abnormal, diseased, 
pathologic, and secondary; but it is important and 
must be squarely met by parents and teachers. 

Special Abuses of Sex in Men. — Premature and 
excessive sexual indulgence interferes with the sex 
development, and thus with the development of the 
entire body and mind. Total abstinence from sex 
indulgence does not in any way retard or prevent per- 
fect development of the sex qualities. Early sexual 
indulgence does interfere with normal sex growth and 
with the strong manly qualities which depend on it. 
Promiscuous indulgence is sure, sooner or later, to 
bring infection by one or both of the venereal dis- 
eases, gonorrhea or syphilis. These diseases arrest 
development and may destroy the whole sex func- 
tions. They are not merely communicable from adult 
to adult, but the germs may penetrate to the testes 
and ovaries, and the sperm and eggs may thus become 
infected. In this way unspeakable disease and misery 
are brought to the next generation as well as this. 

The male has, as a rule, more powerful sex desires 
than the female; but the evils arising from these im- 



5 2 Eugenics. 

pulses and the consequent temptation fall most heavily 
upon the woman; and the venereal diseases are even 
more disastrous to women than to men. 

On these biologic grounds parents and teachers can 
go to their children in the proper way at the proper 
time: "Your development into the manly man or the 
womanly woman that you should become will de- 
pend to a large degree on the health and perfection of 
your sex nature; this is true both of your mind and 
body. If your sex development goes awry, the result 
will certainly show itself in your general qualities of 
body and mind. Even undue thinking of sex matters, 
or yielding to sex impulses, brings a kind of morbid 
regard of them, and an unhealthy mental weakness. 
The purpose of sex knowledge is to enable you to let 
yourself develop normally without giving the matter 
any .unnecessary thought." 

Venereal Diseases. — These so-called social diseases 
are extended through society mainly through prosti- 
tution. They are exceedingly communicable and in- 
sidious, and men and women who lead impure lives 
sexually are certain to be infected with them sooner 
or later. It has been conservatively estimated that 
fully one-eighth of the diseases which afflict humanity 
come from unclean sexual life. The most dangerous 
of these diseases are gonorrhea and syphilis. 

Gonorrhea is caused by a germ which attacks the 



Sex Education. 53 

mucous membranes that line the reproductive pass- 
ages, and may ascend to the remotest organs (the 
ovaries and testes) and produce sterility. In addi- 
tion, the wives of such diseased husbands are often 
rendered invalids for life. Children born of such 
mothers are readily infected, and the disease often 
produces blindness dating from birth; 50 per cent, of 
the inmates of the institutions for the blind lost their 
sight through gonorrhea. It is uncertain whether this 
disease is ever really curable. Infections often occur 
long after the patients believe themselves cured. 

Syphilis is also caused by a germ. This is some- 
what less prevalent than gonorrhea, but it is much 
more dangerous, in that it may be transmitted in 
more ways, and, further, it is capable of being in- 
herited. It is not confined to the sex organs, but be- 
comes a blood disease, reaching the whole system. 
Because of this it may be communicated through any 
mucous membrane or any abrasion of the body. 
Aside from its infectiousness, the children of syphilitic 
parents who have recovered from the disease itself 
are liable to be weak and open to bodily and mental 
diseases. The parents themselves are liable to paral- 
ysis and other permanent nervous diseases. 

These diseases are more than individual matters; 
they are social evils. They break up families, they 
destroy or make innocent wives barren or invalids, 



54 Eugenics. 

they maim and weaken unborn children, and put 
them as a burden on the community, and thus in 
numerous ways strike at its health. 

The Single Standard of Morals. — It is obvious 
that young and inexperienced people cannot find 
within themselves the necessary strength and knowl- 
edge to guide them properly in their sex behavior 
amid the complex temptations which society has 
thrown around them. Not all young people have 
normal home life. It is for this reason that protecting 
standards and conventions are valuable. The insti- 
tution of monogamy and its safeguarding by legal 
sanction should be regarded as sacred. Standards 
which respect and insist on purity in the home are of 
vital importance and should be equally binding on 
both sexes. The salvation of society has been the 
increasingly high standard of morals held up for 
women. If society would rigidly apply the same 
standard to men it would greatly strengthen their 
morality of sex behavior. Public opinion and public 
convention is very important. Our objective in 
education is to secure the internal standards of 
right thinking and acting which will inhibit wrong 
action. 

The Periods of the Child's Life in Relation to Sex 
Instruction. — First period, from birth to eight years; 
second, prepubertal, from eight to twelve years; 



Sex Education. 55 

third, pubertal stage, from twelve to fifteen; late 
adolescent stage, from fifteen to twenty. 

Under eight years of age the teacher should be the 
mother. As a part of the general bodily cleanliness 
there must be care and cleanliness of the external 
genital organs. In either boys or girls the accumu- 
lation of a sort of cheesy looking material causes great 
irritation which may not only lead to inflammation 
of the parts, but calls undue and insistent attention 
to them, and this local irritation which is followed by 
rubbing is often the cause of masturbation. From 
birth an essential part of the daily bath of boys by 
the mother should be a very careful turning back of 
the prepuce and washing off the parts with soft 
cheese-cloth and warm water. In girls the same care 
must be taken to separate the lips of the vulva and 
remove all foreign matter. There must be regular 
daily evacuations of the bowels and the bladder must 
be emptied not less than four times a day. 

The child should for every reason preferably sleep 
alone, with the hands outside the bedclothes; the 
room should be cool and well ventilated. He should 
be made to rise promptly on waking in the morning. 
Great care must be taken to see that the garments 
in the region of the genitals are soft and loose; the 
pockets must be so placed that they do not favor the 
putting of the hands in the region of the genitals. 



56 Eugenics. 

The child should be taught to avoid unnecessarily 
touching these parts for fear of injuring them, just as 
he must keep his ringers out of his eyes. There must 
be an abundance of outdoor life with active play. 

In this early stage the mother should frankly meet 
the questions of the child in such a way as to avoid a 
sense of shame or a cessation of his confidence; to 
arouse a sense of reverent wonder at the mysteries 
of life and the sacredness of the body. 

Parents who are wisely alive to their duty most 
frequently tell the story of mothers and babies to their 
children when they are about eight years old. Often 
they have prepared for it during three or four years 
by lessons in plant life, the building of nests by birds 
and their care of the young. At this age the child's 
power of observation leads to questions. 

The information about reproduction should not be 
abstract generalizations, but be related to that par- 
ticular child, his chickens, his little kittens, babies of 
his own acquaintance. If this period be properly 
dealt with much of the vicious information can be 
anticipated and rendered less harmful. A sense of 
partnership with his parents in this knowledge is 
valuable. The average child learns more during 
these years than at any other period of equal length 
in his life. Much will be gained if sex knowledge can 
take its place normally and without shock. 



ll !, 



Sex Education. 57 

The Prepubertal Stage, from Eight to Twelve. — 
The parents are still in the best position to do this 
work if possessed of the necessary knowledge. The 
purpose of this period is to secure good health and 
good habits, watchfulness on the part of all; the child 
must be kept busy with plenty of outdoor life and 
games to use up his surplus vital energy. There must 
be good books, good companions, and high ideals of 
strong, healthy bodies. 

The direct sex teaching is at this stage at the mini- 
mum. The indirect teaching will be in nature study, 
plant breeding, and similar topics that come up at 
school. 

Children of this age who have been taught properly 
will have had their curiosity satisfied with respect to 
the first mysteries that have raised questions in their 
minds. If this has been properly done, it will tend 
to keep their minds off questions of sex. They are 
not as yet stirred up by their own sex development, 
and normally at this age they are little concerned with 
its questions. Boys are interested in playing with 
other boys, and want to be men; they are not much 
attracted by girls. The manner of approaching them 
should be through physical ambition. They should 
be taught the value of fine bodily and mental traits 
of men; and girls the same desirable traits in women. 
All of this should be quite indirect and incidental. 



58 Eugenics. 

The Pubertal State, from Twelve to Fifteen Years. — 
The attitude is influenced by instruction in the home 
and in school, by the study of biology, botany, zoology 
and physiology, and through nature study and hy- 
giene taught on a biologic basis. 

In school the instruction in physiology and hy- 
giene of the reproductive organs should not be iso- 
lated so as to concentrate the attention on it, but be 
made as it is a natural part of the systematic teach- 
ing of physiology and personal hygiene. For adoles- 
cents the teachers should be of the same sex. Pea- 
body says ("Sex Education in the Home and High 
School/' page n): "I am firmly convinced that no 
man, no matter how well he may be prepared to do 
such work, has any right to attempt to talk to girls 
about these most intimate matters relating to sex. 
The reason for this is that although we want to remove 
the cloak of prudery and shame which have previously 
shrouded this subject, we must take great care not to 
tear away the veil of modesty and delicacy which 
are necessary for its highest interpretation. No man, 
no matter how high minded he may be, can discuss 
these intimate personal matters with a group of 
young girls without injuring their finer sensibilities." 

The girl is now approaching a critical time in her 
life on which her future good health and happi- 
ness will depend, and the ideal instructor for this 



Sex Education. 59 

period is the woman physician, who by her large 
personal contact with women and children is pecu- 
liarly sympathetic and capable of accurately gauging 
the girl's needs. She inspires a feeling of confidence 
in her pupil that must be invaluable to the latter. 

An adolescent girl of fourteen to sixteen should 
know the general plan of her own sexual structure and 
function. Girls should be taught modesty of be- 
havior and avoidance of familiarity on the part of 
boys in games or at any other times. 

Adolescence of Boys. — This is the most critical time 
in the life of a boy. His mother has so far been direct- 
ing him toward purity, and then suddenly sets him 
adrift. If there is ever a time in a boy's whole life 
when he needs intimacy with his mother it is in the 
early adolescent years of from twelve to fourteen 
years. A strong mother's heart-to-heart guidance at 
that time will influence the boy far more than all the 
sex education which the schools and colleges can hope 
to offer. 

A young man's greatest safety lies in having high 
ideals of womanhood, and it is the duty of the mother 
to instil these ideals early in the small boy's life. 

During adolescence the boy becomes conscious of 
the stirring of certain sensations and impulses which 
center in the sex organs, and which may become in- 
trusive in their claims upon his attention. Unless 



60 Eugenics. 

he has been enlightened as to the meaning and true 
use of the sex function and the necessity for its re- 
straint, he is apt to regard these impulses as a suffi- 
cient guide for its exercise. It is at this period also 
that curiosity in regard to sex reaches its highest 
curve, and it is most important that it should not be 
fed from poisonous sources. The social traditions 
which prohibit sound, scientific teaching in regard 
to sex entirely ignores those secret undercurrents of 
corrupt knowledge which circulate everywhere. 

The purpose of the teaching is to secure mental 
preparation for the usual changes that come to the 
body, mind, and morals; to guard against the tempta- 
tions that will come, and so to spiritualize and sub- 
limate the tremendous sex impulses, and to transform 
them into sound ideals and habits of self-controlled 
sex conduct. 

There should be taught the elementary facts of sex 
reproduction and sex in organism, and the changes 
that come to human beings at puberty, the facts 
concerning seminal emissions, their naturalness, their 
meaning, and the methods of self-care that are es- 
sential to good health; the bodily value of sex health 
in after life; the meanings of changes in temperament 
and of sex longings and appetites. Definite warn- 
ings with some reasons should be given, but not over- 
stressed against masturbation; the physiologic con- 



Sex Education. 61 

nection of all this with fine manhood. The mother can 
best reach her son in lessons of chivalry toward women 
as one reason for self-restraint; and in the ideals of 
purity and high standards in relation to women. 

Postpuberal Stage, from Fifteen to Twenty. — At the 
high-school age boys should be taught the scientific 
names of the sex organs, together with the function 
of each part, explained in simple language. Bigelow 
believes that it would be well for boys of adolescent 
years to know a few leading facts regarding female 
structure; such knowledge is best learned from oral 
teaching of a good instructor. The meaning of the 
ovaries as the source of the egg-cells, and of the 
uterus as the place of development of the fertilized 
egg-cell, should be explained in such a way as will 
help boys to get some good fundamental ideas as to 
what motherhood means. Boys should also be in- 
structed concerning the menstrual function; for un- 
less they know, they are sure to misunderstand their 
sisters and other girls. 

The consideration that this discussion of delicate 
questions before a group of boys might set them to 
talking has no weight. As a matter of fact, boys in 
most instances get their ideas of sex matters from 
talking with boys. Practically all of this group have 
a smattering of hearsay knowledge picked up from 
various haphazard sources, either from conversa- 



62 Eugenics. 

tions among themselves or their elders, or from quack 
literature thrust upon their attention. It is simply a 
matter of clearing away the rubbish and error and 
substituting sound, wholesome knowledge. 

Girls in late adolescent years should learn from 
some reliable source the most general facts regarding 
the male structure and function. First of all, many 
of them will need this knowledge for self-protection, 
to forestall more than possible temptation from the 
young man because of his supposed sex needs; the 
majority of girls will at some time have the care of 
children. And some time in adolescent years girls 
should learn the scientific facts regarding mother- 
craft and the care of small children. 

At this vital period of life the mind should be filled 
with high purposes and high ideals; ambitions which 
will absorb the thoughts, strengthen the will; and 
give the beginning at least of a personal vision as to 
how these ambitions are to be carried out and a con- 
ception of the personal qualities which will bring full 
success. The purpose of the instruction at this time 
is to develop the respect for self and others, which 
will tend to inhibit low actions; to enlarge the sense 
of chivalry in boys and of chastity and prudence in 
girls. To stimulate interest in life, in its work and 
opportunities; to make very clear the effect of any 
improper familiarities or sex relations; to utilize the 



Sex Education. 63 

love motive which is large in most youths at this 
time, in order to inhibit improper sex conduct; to 
form and appeal to religious ideals and motives for 
the same purpose. 

Athletics are to be recommended as possessing a 
positive prophylactic value against the indulgence 
of sensual propensities. Physical exercise carried to 
fatigue serves as an outlet for superabundant energy 
which might otherwise be directed toward the sexual 
sphere. Then, again, athletics tend to develop a 
manly spirit, ambition to excel, while the rules of the 
game impose subordination and self-control. The 
mind as well as the body is engaged and participates 
in the benefit. 

An appeal based upon bodily development as a 
motive for purity should have a compelling force 
with boys, among whom admiration for physcial 
development, strength, and vigor is almost universal. 
This plea is more effective when based upon a knowl- 
edge of the intimate relations existing between sex 
function and the physical and mental development 
of the individual. In the normal growth of the body 
it would appear that nature does not occupy herself 
with the provision for the reproduction of the species 
until maturity is attained. All growth is a function 
of nutrition, and during the stage of bodily develop- 
ment the nutritive energies of the system are con- 



64 Eugenics. 

centrated upon the upbuilding of those organs which 
are concerned in the conservation of the individual; 
only after physical maturity is attained does the 
organism produce a surplus of nutrition to be used in 
reproduction. If a demand is prematurely made 
upon this nutritive energy to supply a waste from 
the abnormal secretion and loss of seminal fluid, the 
general nutrition is impaired and the boy does not 
normally develop into a man. 

The body cannot be healthy if any part of it is ill. 
The nerves are the connecting wires which carry 
the news to the brain and all parts of the body. 
They carry the news of weakness; nervousness shows 
itself in irritability and depression. The boy who 
wants to pick a fight with everybody, who is too ugly 
tempered to have around, or who cannot keep at any- 
thing and feels that people don't treat him fairly, 
is the boy who is not treating his body as it should 
be treated, and the nerves are carrying the bad news 
to every part of him. This is just as true of the girl 
of the same sort — her body is out of tune, and the 
chances are that it is her own fault. 

The Control of the Sex Impulse. — Before entering 
the pubescent period every boy should be made ac- 
quainted with the fact that his sex organs are en- 
trusted with the wonderful power of transmitting 
life when he becomes a man, and in order not to 



Sex Education. 65 

impair this power these organs should not be injured 
in any way. The first and most essential condition is 
to create a right and proper attitude toward the 
appetites and passions, to have a right conception of 
the purpose of the reproductive functions as one 
of the most important of the body; hence they must 
be controlled by will and conscience, and exercised 
only in the legitimate way imposed by marriage. 
Every young man should build up high ideals in 
regard to the sex relations, based upon respect for his 
own body, for women in general, and especially for 
the young woman who will one day be his wife and 
to the children he will perpetuate. 

That chastity conduces to health and strength of 
mind and body is a physiologic law, and every young 
man should set before him the ideal of pure and 
vigorous manhood. Clean thinking is an absolute 
essential to clean living. Physical and mental labor 
pushed to the point of fatigue serves to divert the 
energy from the sex organs. 

A valuable inhibitory influence against indulgence 
of the sexual propensities should be a wholesome fear 
of infection. The lowest form of prudence should 
prevent a man from exposing himself to real danger if 
he knows its consequences. 

Marriage and Parenthood. — Love is the finding of 
the person who most needs you and whom you most 
5 



66 Eugenics. 

need; the person who belongs to your own class, who 
has been educated to believe in the same high stand- 
ards which you do, who sympathizes with your fine 
ideals, and so who will be your true mate and faithful 
friend. Every young woman should insist that the 
young man who will be her companion and mate for 
life should bring to the marriage altar the same 
chastity of body and mind which she herself brings. 
The highest form of love is service, and so it 
should be in mating, the altruistic desire to serve the 
loved one; not the material return that is to be had 
out of it. The creative instinct is strongly implanted 
in every normal man and woman, and the desire for 
parenthood in most of them; and in assuming this 
very grave responsibility it is the duty of men and 
women toward their prospective children and the 
community to consider how they can best endow these 
children with the noblest heritage of a pure stream of 
life, sound health, and a proper environment. 

Literature on Sex Education.— Fabre's "The Fly"; Maeter- 
linck's "Life of the Bee"; The Mother's Reply," by Nellie M. 
Smith; "The Boy Problem"; " Instruction in the Physiology and 
Hygiene and Sex"; " Sex in Life," by Donald B. Armstrong, M.D., 
and Eunice B. Armstrong ; " Sex Education in the Home and High 
School," by James E. Peabody, A.M., Head Department, Biology, 
Morris High School, New York City. These pamphlets can be 
obtained of The American Social Hygiene Association, 105 West 
40th St., New York City. 



PART II.-MAIDENHOOD. 



CHAPTER HI. 

PUBERTY* 



Sexual Development; Age of Puberty; Physical 
Changes at Puberty; First Onset of Menstrua- 
tion; Psychic Changes at Puberty; Safeguarding 
Maidenhood. 

"Self-reverence, self-knowledge, self-control, 
These three alone lead life to sovereign power." 

— "CEnone." 

Sexual Development. — Sexual development goes 
on during all the years of childhood, but is not 
complete in the female sex until between the twenty- 
second and the twenty-fifth year. If the child has 
no inherited taint, and has been properly educated 
morally, physically, and intellectually, it must follow 
that the structural development of the pelvic organs 
has been normal; and normal organs always per- 
form their functions perfectly. 

The commencement of the ovarian function does 
not cause any more profound change in the system 
and habits than does dentition. The various epochs 
of life are generally spoken of as if they were 

6 7 



08 Maidenhood. 

paroxysmal — as though they were separated by 
some tremendous chasm, which had to be leapt over 
or fallen into. Nature makes no such egregious 
blunders ; preparations for every change in life have 
been going on for a very long time before the evi- 
dences of such change become manifest. 

In a healthy girl the psychic and physical changes 
incident to puberty occur so gradually as to escape 
the girl's own notice. The first and, if the girl has 
not been properly prepared for it, always startling 
change is the appearance of the menstrual flow. 
The mother who has not told her daughter of this 
coming change in her life before it is due has com- 
mitted a serious error; it is no uncommon occur- 
rence for girls who know nothing of this function 
to get into a tub of cold water to stop the flow ; and 
if they stay in long enough, it generally does stop, 
and the girl's health may be ruined for life. 

The opinion of Dr. Ely van de Warker is that 
" if healthy ovulation is the outcome of healthy 
childhood, the function will obey the law of peri- 
odicity year by year, and all this time the young 
woman will be able to sustain uninterrupted physical 
and intellectual work as well as the young man. 
Not that the laws of health may be violated with 
impunity at puberty or any other time of a woman's 
life; but a law of health is no more binding upon 
a young woman than it is upon a young man; and 



Puberty. 69 

there really is no such thing as one law for women 
and another for men." 

Age of Puberty. — In the temperate regions the 
age of puberty is reached between the ages of twelve 
and fourteen years. The girl is then said to be 
nubile; that is, as soon as menstruation appears it 
is possible for her to bear children; but she is by 
no means sufficiently developed to do so, as she 
herself will not be completely developed physically 
or mentally before the age of twenty-two or twenty- 
five years. 

Physical Changes at Puberty. — The physical 
changes that gradually take place, beginning at the 
time of puberty, are: the breasts, pelvis, and neck 
enlarge; hair develops over the pubis and in the 
arm-pits; the voice alters. As a rule, women con- 
tinue to grow in stature until the twenty-fifth year. 
It is said that brunettes develop sooner than blondes, 
and that large women develop more slowly than 
women of small stature; city girls develop younger 
than girls brought up in the country. Whatever 
stimulates the emotions causes a premature devel- 
opment of the sexual organs; as children's parties, 
late hours, sensational novels, loose stories, the 
drama and the ball-room, talk of beaux, of love 
and marriage, and children being surrounded with 
the atmosphere of riper years. It is generally be- 
lieved that early stimulation of the sexual instincts 



70 Maidenhood. 

leads to the premature establishment of puberty, as 
do also spiced foods and alcoholic beverages. 

First Onset of Menstruation. — Sometimes the 
first menstrual discharge appears suddenly, lasts for 
a few days, and then stops; it may appear after an 
interval of two or three weeks, or not for several 
months. If for several months the flow appears 
at the regular time, and the quantity is about the 
same as the first, the menstrual habit may be said 
to be established. The mode of onset varies con- 
siderably within the limits of health. So long as 
the general health remains good, no anxiety need 
be felt in regard to the establishment of the men- 
strual function. 

In other cases there may be a discharge of blood 
at the first period, and none afterward for several 
months; in other words, menstruation may be es- 
tablished suddenly, intermittently, or gradually. It 
must be remembered that certain pathologic condi- 
tions cause many disturbances connected with the 
onset of puberty. 

Psychic Changes at Puberty. — The angular, 
gawky feeling gradually disappears; the girl be- 
comes self-conscious; new impulses arise, and she 
gives up many of the hoydenish ways of childhood. 
The girl's imagination is more lively, and just at this 
time mathematics form an excellent subject for men- 
tal occupation. The girl now begins to question 



Puberty. 71 

the whys and wherefores, and demands reasons for 
the course that is laid out for her, and is full of 
ideas of her own ; so that while as a child she had 
accepted almost unquestioningly the commands of 
her parents, she can be managed now only through 
the power of reason. And this is just as it should 
be, for the girl has reached the years of discretion, 
and now is the time when her reason and judgment 
are capable of rapid cultivation. 

Safeguarding Maidenhood. — The girl has now 
reached the most critical period of her life not only 
physically but psychologically; for the bent now 
given to her body and mind will decide all of her 
future life and either make or mar it. This girl, who 
heretofore has been carefully shielded in the home, 
is now suddenly thrown into a large social vortex of 
school life, among boys and girls with very different 
views of life. Too much care cannot be taken by her 
mother in aiding her in the selection of her friends, 
books, and social amusements, for these will shape her 
ideals for future conduct. At this particular time 
the influence of religion is most potent and valuable. 
And just at this most vulnerable age, when they 
are least able to resist temptation, it has become the 
unfortunate custom here in the States to most un- 
necessarily expose our daughters to the evil in- 
fluence of the thoughtless, the ignorant, and the 



72 Maidenhood. 

vicious. Friendships are either elevating or de- 
basing, they are never absolutely negative. The 
young of both sexes are thrown too indiscriminately 
together. There are certain safeguards which the 
community should erect. 

The conventions which control intimacy between 
the sexes are one of the most important of these. 
On the one hand, a wholesome comradeship between 
boys and girls should be encouraged, not only for the 
removal of loneliness and morbid curiosity, which are 
among the greatest of the sex irritants, but that in 
growing up together from childhood in a normal way 
the sexes may better understand each other. On the 
other hand, the attraction of the other sex may easily 
draw too much attention from the studies and sports 
that ought to make up the bulk of the activity of 
youth; and too great freedom of companionship leads 
to an unnecessary amount of temptation. Close lines 
must be drawn and a very considerable amount of 
wise chaperonage is necessary to keep intact the 
normal modesty and reserve that must always be 
preserved between young people. Too free physical 
intimacy breaks down these natural barriers and 
often leads to moral downfall. 

Certain abstinences, that might not seem in them- 
selves important, are essential. Little familiarities, 
caresses, kisses at all times must be avoided; they are 



J 



Puberty. 73 

like playing with fire, and the youth never knows 
when the electric thrill will vibrate through his being, 
awakened by a touch, that may break down all of his 
previous good resolutions; that would injure his 
future success and wreck the life of his companion. 

The finest men do not take these liberties, nor do 
well-bred girls permit them or respect those who seek 
them. Vulgar jokes and stories must be tabooed, as 
well as all allusions to vice as a natural or amusing 
thing. All unhealthy excitements, alcohol, and 
gambling must be shunned. Above all, the imagina- 
tion must be controlled; nothing is more dangerous 
than the indulgence in voluptuous dreams. Long- 
ings so fostered, so pent up without outlet are apt to 
break out in spite of scruples and resolves, if a favor- 
able and alluring opportunity presents. The contin- 
uous mental attitude toward chastity will decide the 
issue of the battle at the actual moment of tempta- 
tion. 

Normal friendships with pure women are vitally 
necessary for men, and comradeships with men are 
important for women. Normal interests of all sorts 
are important; the man or woman who has a full 
all-round life, who cultivates wholesome intellectual, 
esthetic, and religious activities, is in far less danger 
of an unregulated passion. Human energy must find 
some happy outlets or it will tend to run amuck; what 



74 Maidenhood. 

we become depends largely in what we get interested. 
Abundant physical outdoor life and sports lessen im- 
moderate desires. 

A very important duty of the community lies not 
only in the fight against all that is obscence in books, 
pictures, plays, movies, and the ballet, but to sub- 
stitute for these good, clean, invigorating amuse- 
ments in various social centers. Parents must bear 
in mind that in order to properly protect their own 
children they must assist in the general uplift of the 
entire community. Corrupt morals carry with them 
a more deadly contagion than does bodily disease. 



CHAPTER IV. 

HYGIENE OF PUBERTY. 

Home Life; Corsets; Girdles; Shoes; Underwear; 
Nutrition; Diet; Water; Constipation; School 
Life; Spinal Curvature; Exercise; Walking; Run- 
ning. 

"Every man is the architect of his own fortune." 

Pseudo-Saij«ust. 

Home Life. — With beginning menstruation the 
equilibrium of the body is very easily disturbed, so 
that even in the case of the healthy girl some pre- 
cautions should be taken and a rational regime 
should be adhered to ; while in" the case of the deli- 
cate girl a still more careful attention will have to 
be directed toward her weak points, in order that 
she may develop into a healthy woman. 

For every girl at this time of life home is pre- 
eminently the place ; so that she may not only have 
the benefit of a mother's watchful care, but also 
lead a life as free from conventionalities and as 
much in the open air as possible. No girl should 
be sent away to school at this period of rapid growth 
and development; nor should girls of the working 

75 



7^ Maidenhood. 

classes, when it can possibly be avoided, be sent 
out to fill positions as clerks in illy ventilated stores, 
in factories, or as domestics. If a girl can be kept 
at home until she is eighteen years old, she will be 
a much stronger, healthier woman than would other- 
wise be possible. 

Corsets.* — At this period of life it is particularly 
necessary that the clothing should be warm and at 
the same time sufficiently loose to prevent the con- 
striction of any part of the body. And whatever 
the adult woman may elect to do in the matter of 
wearing corsets herself, she does her young daugh- 
ter an irreparable injury by constricting and mould- 
ing her growing body in these corset-splints. Cor- 
sets placed on the young girl interfere with the 
functions of circulation, respiration, digestion, and 
of the pelvic organs, also with muscular develop- 
ment. In addition to all this, the girl is handicapped 
in taking all outdoor exercises and athletic sports. 

The lungs, heart, and great blood-vessels are 
placed in and completely fill an air-tight, distensible 
cage, which is most distensible at its base. 

The least chest girth of the adult woman — that 

is, the under-arm girth around the chest — that is 

consistent with health is twenty-eight inches; and 

* An interesting and instructive dissertation on The Influence of 
the Corset on the Female Body will be found in "Personal Hygiene 
and Physical Training for Women" {Second Edition), pages 260-275. 



Hygiene of Puberty. 77 

this girth must be enlarged three inches in forced 
inspiration. In ordinary respiration the waist ex- 
pansion should be one-half to one inch, while during 
great muscular activity it should be from one and 
a half to three or four inches. One-third of the 
lungs lie below the point of beginning corset pres- 
sure, so that with tight corsets this amount of lung 
substance must be more or less useless. 

It is self-evident that any restriction placed about 
the waist, by preventing the full expansion of the 
ribs and the descent of the diaphragm, will further 
embarrass the heart's action by diminishing the 
amount of room it has to work in, at the same time 
that it diminishes the amount of oxygen which is 
inspired. Fresh air is by far the most important 
part of the daily food. It is in the lungs that the 
blood throws off its carbonic acid and other impuri- 
ties; but it is able to do this only when the lungs 
are supplied with an abundance of oxygen. Every 
inch which a woman adds to her chest measure adds 
to the measure of her days. 

Great physical injury has followed women play- 
ing lawn-tennis while tightly corseted. And although 
dancing is a much milder exercise, since it frequently 
takes place in an overheated and poorly ventilated 
room, fatal results occasionally occur from the same 
cause. 



78 Maidenhood. 

Standing erect calls into action almost all the 
muscles of the trunk, neck, and lower extremities. 
So long as the line of gravity falls within the area 
of the feet, the muscular effort required is so slight 
that it is little more than the tonicity contained in 
all living muscle. The greater the displacement 
of the line of gravity, the greater the muscular 
effort required to maintain the equilibrium of the 
body. Up to a certain extent, exercising the muscle 
develops the strength and size of the muscle. On 
the other hand, when a muscle within the body is 
unused, it wastes; when used within certain limits, 
it grows. But when the corset splint is applied to 
the body of the young girl, it supplants the func- 
tions of the abdominal and back muscles, which 
is to hold the trunk erect, and these muscles gradu- 
ally grow weak and waste. And so the liability 
to the various spinal curvatures is increased. 

By interfering with the muscular development 
and digestion, the girl is very apt to become angular, 
flat-chested, anemic, and to have a muddy com- 
plexion. And so the corset really defeats the object 
for which it was put on — that of giving the girl 
a good figure and enhancing her beauty. 

There is no objection to girls wearing any of 
the various forms of hygienic waists now on the 
market. 



Hygiene of Puberty. 79 

Girdles. — Many women now prefer abdominal 
girdles to any style of corset, especially for dancing 
and outdoor games and sports. A very popular 
one is the Treo Elastic Girdle, which allows great 
freedom of movement; these girdles come in lengths 
varying from 10 to 16 inches and have four hose 
supporters. 

Shoes. — The feet are the part of the body to come 
in contact with the greatest degree of cold, whether 
on the floor of the house or the pavement of the 
street. Hence it is a matter of prime importance 
to the entire body that the feet should be properly 
clad. 

The thick-soled, flat-heeled shoes which became 
popular with bicycling and golf are most hygienic, 
and it is highly desirable that this style of shoe 
should be adhered to for outdoor exercise. 

Underwear. — In our cold and changeable climate 
the most suitable undergarment is the " combina- 
tion " woolen undersuit, which reaches from neck 
to ankles and has long sleeves. Much greater 
warmth is afforded when the undersuit is moderately 
tight fitting. Such a suit should be worn the entire 
year, the grade of weight being adapted to the 
season. 

Nutrition. — The nutrition of the body is depend- 
ent on the food supply, digestion and excretion. 



80 Maidenhood. 

The growing girl should eat more than the adult 
woman, because of her more active life and of the 
fact that the food which she takes must not only 
replace the worn-out material of the body, but also 
provide new material needed for growth. Insuffi- 
cient food and food of defective quality and com- 
position work proportionately for more harm dur- 
ing the growing age. 

The full adult weight is not attained before the 
twenty-fifth year. When the final growth of the 
body and development of the vital organs is com- 
pleted, the function of food is simply to replace 
waste with new material and to furnish material 
for the development of force. 

Diet. — The diet should be a mixed one, consisting 
of the various kinds of fresh meats, fish, milk, eggs, 
poultry, vegetables, fruit, and fat in the shape of 
cream, butter, and the fat of beef and mutton. 
Animal food improves the condition of the muscles, 
which are made firmer than they would be through 
a vegetable diet. Meat in general has a more stim- 
ulating effect upon the system and is more strength- 
ening than vegetable food, and it gives rise to a 
sensation of energy and activity. The common 
estimate is that meat should occupy one-fourth and 
vegetable food three-fourths of a mixed diet. 

Common salt in moderate quantity is essential, 
but all highly spiced or seasoned foods should be 



Hygiene of Puberty. 81 

avoided, also pickles and vinegar. All " sweets " 
are harmful, because they destroy the appetite for 
other things and upset the digestion. Tea and 
coffee should be tabooed, as well as all alcoholic 
beverages. 

Good digestion depends for the most part on 
serving the meals at the same hour every day, eat- 
ing leisurely, and masticating the food well. There 
is a great tendency on the part of the school girl 
to sleep late in the morning, then " bolt " her break- 
fast in order to get to school in time. Nothing 
could be more pernicious to the digestion, unless 
it is the eternal nibbling of candy. 

A healthy girl needs nothing between meals. A 
delicate girl will be the better for a glass of milk 
in the middle of the morning and at ted-time ; or 
pure beef juice may be given instead. 

Water. — Water is needed to keep the kidneys 
properly flushed. The amount of urine secreted 
during the twenty-four hours should be three pints. 
Of course it will be less than this if the quantity 
of water is insufficient. In addition to the urine 
about ten ounces of water are lost from the surface 
of the lungs, and eighteen ounces from the skin, 
making a total of about five pints; and this quan- 
tity of water must be taken daily in order to main- 
tain the equilibrium of the body. The solid food 
of a mixed diet contains from fifty to sixty per 
6 



82 Maidenhood. 

cent, of water, so that about twenty-five ounces of 
water are taken into the system daily as an integral 
part of the food. In addition, three pints more 
should be taken as plain water. The bladder acts 
as a reservoir for the urine, and should be emptied 
at least three or four times a day. 

Constipation. — In order to keep the digestive sys- 
tem in good condition, the refuse matter which 
collects in the lower bowel must be evacuated every 
day. And in order to secure this regular bowel 
movement, regularity in the time of going to the 
toilet is a prime necessity. And now is the time 
when the habits of a lifetime are being formed. 
If a tendency to constipation exists, it can almost 
always be overcome by increasing the amount of 
fruit and vegetables eaten, also by eating cracked 
wheat, oatmeal, corn and graham bread; all of 
which increase the peristaltic action of the intes- 
tines. The small amount of water taken by girls 
and women is another fertile source of constipation. 

School Life. — When it is considered that fully 
one-half of the girl's waking hours are spent in 
school or in study preparing for school, it becomes 
evident that the girl's attitude at her desk should 
be the correct one. The malpositions at the desk 
are the most frequent cause of lateral curvatures, 
round shoulders, and flat chests. And these deform- 
ities are more common in girls than they are in boys. 



Hygiene of Puberty. 83 

The common faults of the desk and seat leading 
to these malpositions are unsuitable shape of the 
back of the seat, too great a distance between the 
seat and the desk, and the incorrect slope of the 
desk. 

The edge of the desk should slightly project over 
the edge of the chair. The top of the desk should 
incline downward about ten degrees toward the 
student, and be low enough to allow the forearm 
to rest on it without raising the shoulder. The 
seat should be sufficiently deep to support almost 
the entire thigh, and close enough to the floor to 
allow the soles of the feet to rest firmly on it. The 
back of the chair should be arched so as to support 
the hollow of the back, and should reach just above 
the lower part of the shoulder-blades, and so make 
it easy and comfortable for even a weakly child 
to sit upright. 

If the seat is too high, the feet do not rest on 
the floor, and so the girl does not get the proper aid 
from the legs and feet to maintain an erect position. 
If the desk is too high, the elbow can rest on it 
only by curving the spine and raising the shoulder. 
The work is brought too close to the eyes and 
causes extra strain. If the desk is too low, the 
child stoops over it and becomes round-shouldered, 
and there is a tendency to become short-sighted. 

The pupil should sit erect with the weight equally 



84 Maidenhood. 

borne by both buttocks; the legs should be straight 
before the trunk, and the feet firmly resting on the 
floor. The book should be held about twelve inches 
from the eyes. 

Spinal Curvatures. — It should be distinctly borne 
in mind that lateral curvature of the spine is a 
distortion of growth. The deformity appears and 
is developed during the growing years. It is more 
common in girls than in boys, for two reasons : that 
at the age when lateral curvature is first seen, girls 
grow more rapidly than boys; and their muscular 
system is less well developed. 

In most early cases the faulty attitudes are clearly 
the result of muscular weakness. The growth in 
size has not been accompanied by a corresponding 
development of the muscles. This condition is most 
frequently met with in rapidly growing girls, and it 
is one of the most common causes of lateral curva- 
ture. In these cases proper gymnastics are indi- 
cated, but they should be prescribed and carried out 
with much care. 

It is upon the erectness, suppleness, and strength 
of the spinal column that most of the power and 
grace of the body depend. 

Lack of ventilation is a fertile cause of headache, 
anemia (or an impoverished condition of the blood 
in iron and oxygen), and dyspepsia. All these are 
rare before but common after twelve years of age. 



Hygiene of Puberty. 85 

Exercise. — In physical culture the object aimed at 
should be the symmetrical development of all the 
muscles of the body. Hence the necessity for bring- 
ing every individual muscle into play, at first for its 
development, and later for its maintenance. 

The tendency of almost all forms of exercise is to 
develop some portion of the body at the expense of 
the rest. The most perfect form of exercise is 
therefore that one which will most nearly call into 
play all the muscles of the body. 

Walking. — Walking is the only form of exercise 
which may be said to be universal. In walking the 
muscles of the chest get little exercise, and those 
of the spine and abdomen even less. In walking 
the arms should swing easily at the sides, both 
from a physiological and an esthetic point of view. 
If the girl is weak or is unaccustomed to take any 
exercise, the guide for the amount of exercise taken 
at any one time must be this : At the first sense of 
fatigue, stop at once and rest, otherwise positive 
harm instead of good may be accomplished. The 
girl who depends on walking for her outdoor exer- 
cise should walk at least three miles every day, and 
walk at the rate of three miles an hour. 

After acquiring as great a walking speed as is 
consistent with a graceful and easy carriage, the 
running exercise should be begun, gradually increas- 
ing the distance, but not the rate of speed. 



86 Maidenhood. 

In exercising, all tight clothing about the neck, 
chest, and waist must be removed. Pure air and 
full breathing are required during and after exercise. 
Full breathing not only promotes the change of air 
in the lungs, but also quickens the functions of the 
circulation and digestion. Eating must be avoided 
shortly before or shortly after any considerable ex- 
ercise, as it impairs digestion. 

Running. — Running is the best exercise for de- 
veloping the breathing capacity. While brisk walk- 
ing is allowable, fast running is not. The rule for 
running is to begin slowly, run moderately for per- 
haps fifty feet, then increase the speed gradually; 
but in running for exercise, never speed to the 
utmost. A five-mile gait is quite sufficient. The 
run should be closed with the same moderation with 
which it was begun, and the girl should never stop 
short, as this sudden arrest of action gives a most 
undesirable shock to the heart. 

In beginning to take any form of exercise the 
intensity and duration of the movements practiced 
must be increased very gradually, or positive harm 
instead of good will be done. As soon as fatigue 
is appreciable, the exercise should be discontinued 
and at once be followed by complete rest. Rapid 
respiration, palpitation or dizziness, headache, the 
face becoming pale or pinched or flushing suddenly, 
a feeling of great heat or excessive perspiration, are 



Hygiene of Puberty. 87 

all danger signals showing that the exercise has 
already been carried too far and should cease at 
once. Continued over-exertion carried to a point 
of exhaustion leads to an obstinate irritability of the 
heart as well as to organic lesions. 

Mountain-climbing, rowing, -and bicycling call 
into play almost all the muscles of the body. Of all 
the outdoor exercises for girls, swimming is one of 
the most perfect. It not only calls into vigorous 
action most of the muscles of the body, but spares 
many of those muscles that are so commonly over- 
worked, the most of the work being performed by 
muscles that are so little used as to have become 
flabby and weak. 

Swimming and sea-bathing must be avoided by 
girls who have weak hearts and in whom the reac- 
tion after a plunge into cold water is never estab- 
lished; also by girls with heart disease or kidney 
disease. 

The principal outdoor games are croquet, archery, 
golf, tennis, cricket, foot-ball, and base-ball. Of 
these, croquet is the mildest, and is for that reason 
a good beginning exercise. Croquet, archery, golf, 
and tennis are all defective in that they cause a 
greater development of the right than of the left 
side of the body. 

As the greater majority of these outdoor exercises 
can only be indulged in for seven months of the 



88 Maidenhood. 

year, they should be supplemented by exercises in 
the gymnasium for the remaining five winter 
months. 

There should be the greatest variety possible in 
the kinds of exercise taken, not only to develop the 
body symmetrically, so as to obtain strength, vigor, 
grace, celerity, and accuracy of movement, but also 
because there is no such potent cause of fatigue as 
monotonous repetition of the same act, whether phy- 
sical or mental. 

It has been repeatedly proven that physical de- 
terioration can be overcome by exercise, and that by 
so doing the mental capacity is greatly increased. 



CHAPTER V. 

ANATOMY OF THE FEMALE 
GENERATIVE ORGANS. 

The Vulva; the Hymen; Condition of the Hymen 
as a Proof of Virginity; the Bladder; Vagina; 
Uterus; Respiratory Movements of the Uterus; 
Fallopian Tubes; Ovaries. 

"He that respects himself is safe from others; 
He wears a coat of mail that none can pierce." 

LoNGFEIrLOW. 

The Vulva. — The female generative organs con- 
sist of three groups — the external, the intermediate, 
and the internal. The vulva, or external generative 
organs, comprises all those organs which are ex- 
ternal to the body. 

The vulva is pierced by two openings, the smallest 
and most anterior of which is the external opening 
of the urethra, or excretory duct of the bladder. 
This opening is surrounded by a slight eminence 
and has a somewhat puckered aspect. 

The larger opening is the vaginal orifice. In the 
virgin this is partially closed by the hymen. About 
one inch back of this is the anus, or the external 
orifice of the' large bowel. This part of the bowel 
is known as the rectum. 

89 



90 Maidenhood. 

The Hymen. — The hymen consists of a thin dup- 
licative of mucous membrane strengthened by 
fibrous tissue, and is stretched across the posterior 
part of the vaginal orifice, which it partly occludes. 
Rupture of the hymen usually, but not always, 
occurs during the first sexual intercourse. In rare 
cases it is found intact at the time of the birth of the 
first child. In women who have borne children the 
vaginal orifice is surrounded by small irregular 
elevations; these are the remains of the ruptured 
hymen, but are usually present only after labor has 
taken place, since the torn hymen is converted into 
eminences as the result of the pressure incident to 
child-bearing, and not to coitus. 

The Condition of the Hymen as a Proof of Vir- 
ginity. — Formerly much stress was laid on the con- 
dition of the hymen as a proof of virginity. The 
hymen tightly closed, barely admitting the tip of 
a small index-finger, is positive evidence of vir- 
ginity. But the hymen may lose its tone by a local 
catarrhal condition or by a general muscular relax- 
ation ; it may then become so relaxed that the only 
positive evidence rendered by the intact hymen is 
that the woman has not borne a child. "The truth 
is that the hymen is a worse than useless relic of em- 
bryologic development, and it is neither an indicator 
nor dictator of morality."* 

* Bigelow, "Sex Education," p. 153. 



Anatomy of the Female Generative Organs. 91 

In a paper on the preservation of the hymen, Dr. 
Hannah M. Thompson writes : " Further, if the 
hymen was intended as a guarantee of moral char- 
acter, and for moral protection, either of man or 
woman, would we not have some reason for reflect- 
ing on the wisdom and righteousness of a Creator 
who has failed to make equal provision, and to give 
a like guarantee of an uncorrupted manhood? As 
physicians, we know too well that where one woman 
enters the marriage relation tainted in body there 
are thousands of men reeking with disease; and 
there is no demonstrable test to distinguish these, 
no proof for the young woman of the virginity or 
virtue of the young man." 

The Bladder. — The female bladder is relatively 
broad and capacious, and is also highly distensible. 
When the bladder is allowed to become overdis- 
tended, it is carried backward and tends to cause 
a backward displacement of the uterus. The 
urethra, or excretory duct of the bladder, is about 
an inch and a half long, and lies firmly imbedded 
in the anterior vaginal wall. 

The Vagina. — The intermediate organ is the va- 
gina. This is a musculo-membranous canal which 
connects the external with the internal organs of 
generation. The vagina lies in relation with the 
bladder and the urethra in front, and with the rec- 
tum behind. The vagina is sufficiently distensible 



92 Maidenhood. 

to allow of the passage of so large a body as the 
child. 

The Uterus. — The internal organs of generation 
are the uterus, the ovaries, and the Fallopian tubes. 
Of these, the ovaries and the uterus are the essential 
female organs of generation. The virgin uterus 
is a small, hollow, muscular organ, somewhat pear- 
shaped, whose cavity is about one and a half inches 
deep. The uterus is divided by a natural constric- 
tion into a body and a neck. The neck, or cervix, 
is somewhat spindle-shaped, and has a canal run- 
ning through its center which opens by a small aper- 
ture — the so-called external orifice, — into the va- 
gina. In the virgin uterus the apposition of the 
anterior and posterior walls reduces the cavity to 
little more than a longitudinal cleft. With the 
advent of old age the whole organ suffers marked 
atrophy. 

'The uterus is situated in the middle of the pelvic 
cavity, between the bladder and the lower bowel. 
It is held in place by broad elastic bands which go 
to different sides of the pelvis; it is also, in part 
supported by the structures below and above it. But 
so loosely is the uterus held that it is easily pushed 
about — as, for instance, by a full bladder or a 
packed bowel. And persistently allowing the blad- 
der to become overfull, and failure to have a daily 



.Anatomy of the Female Generative Organs. 93 

evacuation of the bowels, are prolific sources of 
displacements of the womb. 

Respiratory Movements of the Uterus. — When 
no constrictions are placed about the waist, the 
uterus moves freely up and down with every res- 
piration. So distinctly and with such regularity 
do these movements take place that an operator by 
watching the movements of the uterus can tell the 
effect that the anesthetic is having on the patient's 
breathing. These so-called respiratory movements 
play a very important role in the circulation of the 
uterus, and in the return of the venous blood to the 
heart. 

Anything which interferes with these movements, 
as the use of corsets, or of tight bands around the 
waist, prevents the free return of the venous blood. 
The uterus becomes congested, and through the 
constant abnormal weight of the organ itself, as 
well as the pressing down upon it from above of 
the superincumbent organs, the uterus is pushed 
down below its normal position, the ligaments whose 
duty it is to hold it up become relaxed, and the 
unhappy woman suffers all the agonies that are 
attendant on the " falling of the womb." For this 
reason the disorder is frequently met with in women 
who have never borne children as well as in those 
who have. 

The Fallopian Tubes.— The Fallopian tubes ex- 



94 Maidenhood. 

tend from the upper, rounded angles of the uterus, 
within and along the free margin of the broad liga- 
ments, for a distance of about two inches, to the 
vicinity of the ovaries, where each one terminates 
in a funnel-shaped orifice surrounded by a series 
of fringed processes. The lumen of the tube is 
narrowest at its inner end, where it opens into the 
cavity of the uterus by a minute orifice which 
scarcely admits a bristle; the diameter of the canal 
gradually increases until it reaches its ovarian ex- 
tremity. The mucous lining of the tube is clothed 
by a single layer of hair-like epithelium, whose 
current sweeps from the ovarian toward the uterine 
end of the tube; and it is these movements which 
propel the ovum from the ovary to the uterus. 

The Ovaries. — The ovaries are two small bodies 
of an almond shape, and lie on either side of the 
uterus. The bulk of the entire organ consists of 
connective tissue, in which lie imbedded the Graafian 
follicles or ovisacs, in which the ova are contained. 
These follicles or ovisacs are minute cells which 
are packed immediately beneath the surface, where 
they occur in all stages of development. With the 
increase in size which accompanies their develop- 
ment the follicles pass toward the surface, where 
they form a distinct projection, and at this point will 
occur the final rupture of the sac and the escape 
of the ovum. It is supposed that the ovum is grasped 



Anatomy of the Female Generative Organs. 95 

by the fringe-like extremity of the Fallopian tube 
and is carried through it by the movements of the 
ciliary epithelium to the uterus. 

The formation of new follicles continues only for 
a short time after birth, when the Graafian follicles 
are the most numerous ; the entire number contained 
within the ovaries of the child being estimated at 
over 70,000. In view of the unquestionably large 
number of follicles in very young ovaries, and the 
relatively small number of ova which reach maturity, 
the degeneration of many follicles after reaching 
a certain degree of development seems certain. 



CHAPTER VI. 

PHYSIOLOGY OF THE FEMALE 
GENERATIVE ORGANS, 

Ovulation; Etiology of Menstruation; Uterine 
Nerve-supply; the Function of the Uterus; Stages 
of the Menstrual Cycle; Average Duration of the 
Menstrual Flow; Character of the Flow; Rela- 
tion of Ovulation to Menstruation; the Menstrual 
Wave ; Definition of Menstruation; Premonitory 
Symptoms of the Flow; Hygiene of Menstruation. 

"Toil and grow strong; by toil the flaccid nerves 
Grow firm, and gain a more compacted tone." 

— Armstrong. 

Ovulation. — At birth the formation of the ova is 
nearly completed ; the production of new cells prob- 
ably ceases after the second year. The ovaries of 
the child of two years contain, therefore, the full 
quota of ova, although the vast majority of these 
cells always remain immature and undeveloped. 
While it is probable that a variable number of the 
immature ova undergo partial development before 
puberty, yet the advent of sexual maturity at that 
time marks the establishment of the regular devel- 
opment of the Graafian follicles and their contained 

9 6 



Physiology of the Female Generative Organs. 97 

ova, accompanied by the attendant phenomena of 
menstruation. 

During the entire child-bearing period, or from 
about the age of fifteen to forty-five years, the devel- 
opment of the Graafian follicles and the discharge 
of the ova are continually taking place. The libera- 
tion of the ova usually takes place at definite times, 
which in general coincide with the menstrual epochs, 
one or more ova being set free at each period ; but 
this is by no means invariable. 

The ripe human ovum or germ cell is a spheric 
cell, about 0.2 mm. in diameter, consisting of gran- 
ular protoplasm, in which lies a nucleus which con- 
tains the germinal spot. The proper cell-wall is 
a structure of great delicacy, outside of which is a 
secondary envelope. 

Menstruation. — The etiology of menstruation has 
been variously explained at different epochs. The 
chief theories have been that of plethora, and the 
ovulation, the tubal, and the nerve theories. 

First, the Theory of Plethora. — From the time of 
Hippocrates to 1835 the theory prevailed that in the 
female body the formation of blood is sufficiently 
rich to provide every four weeks for an overflow 
of the same, the evacuation of which becomes a 
necessity. It was believed that this excess of blood 
depended on an excess of formative power in the 
woman. 
7 



98 Maidenhood. 

Second, the Ovulation Theory. — This was dis- 
tinctly formulated about 1845. I* construed the 
menstrual hemorrhage as a subsidiary phenomenon, 
entirely dependent on the periodic dehiscence of 
ovules. The changes supposed to take place in the 
Graafian follicles at each menstrual period were 
believed to involve a peculiar expenditure of nerve 
force, which was so much dead loss to the individ- 
ual life of the woman. The growth of the Graafian 
vesicle and its contained ovum was supposed to 
cause an irritation of the nerves of the ovary, which 
was reflected to the entire nervous system. The 
gradual accumulation of this irritation finally caused 
a reflex action which determined an afflux of blood 
to the uterus and ovaries, which constitutes the 
catamenial flow. 

The ovulation theory was refuted by the follow- 
ing facts: Ovulation may and does occur without 
menstruation ; women who have never menstruated 
may conceive; conception may occur during lac- 
tation, without the menses having returned since the 
last parturition ; children at birth have many ovules 
contained within the ovaries ; ovulation may persist 
for a time after the menopause, and even pregnancy 
has occurred, although very rarely after this time; 
the menses may continue regularly after the removal 
of the ovaries and Fallopian tubes; this is excep- 
tional, and, as a rule, the periods only continue for 



Physiology of the Female Generative Organs. 99 

two or three years at longest. 

Third, the Tubal Theory. — Lawson Tait thought 
that thorough removal of the tubes was far more 
essential in determining the menopause, and that 
cases of periodically recurring hemorrhage after 
the removal of the ovaries were to be explained by 
the fact that the tubes had not been sufficiently re- 
moved. As an anatomic and surgical fact, the tubes 
can never be wholly excised unless the upper part 
of the uterus is also amputated. 

Fourth, the Nerve Theory of Menstruation. — This 
is based upon the following views : 

1. That menstruation is a process directly con- 
trolled by a nerve-center situated in the lumbar 
region of the spinal cord. 

2. That the menstrual impulses reach the uterus 
through two sets of nerves. 

3. That menstruation is the result of nerve irri- 
tation, vascular congestion, and the subsequent relief 
of thess by hemorrhagic discharges. 

4. That hemorrhage from the uterus is the result 
either of a local uterine condition, or of influences 
outside of the uterus acting directly on the center. 

5. That the removal of the appendages arrests 
menstruation by preventing the propagation of uter- 
ine influences to the center. 

Uterine Nerve Supply. — One set of nerves causes 
contraction of the muscular fibers of the uterus, 



ioo Maidenhood. 

while the other set transmits impulses which bring 
about its vascular engorgement ; and they are prob- 
ably concerned in bringing about the determination 
of blood to the uterus and its appendages, which is 
so marked a feature of the menstrual process. 

As the result of long-continued investigation, 
Johnstone has come to the conclusion that the lining 
membrane of the uterus belongs to that class of 
organs whose function it is to replace organic waste. 
" Menstruation is a periodic wasting away of those 
corpuscles that are too old to make a placenta." 
He has further found that, as compared with the 
uteri of very many of the lower animals, the human 
uterus is very scantily supplied with lymphatics, and 
the only way to rid the uterus of the overripe, and 
therefore consequently useless, tissue is to wash it 
out through the vagina by a blood-stream. The 
tough wall of the human uterus and the increased 
blood-pressure caused by the erect position cause 
the difference between menstruation in the human 
female and rut in the lower animals. 

The strong light O'f recent investigations has 
necessitated the laying aside of many time-honored 
theories ; and as the close of the nineteenth century 
has seen the emancipation of the uterus from the 
thralldom of the ovary, so we may believe that the 
twentieth century will find women of such fine phy- 
sique as to prove the error of the popular fallacy 



Physiology of the Female Generative Organs. 101 

that the cause of woman's weakness lies in the per- 
formance of her functions. 

The Function of the Uterus. — The function of 
the uterus is to provide a favorable place for the 
reception of the product of conception, where it may 
be protected and nourished during the period of its 
development. The purpose of menstruation is to 
keep the uterus in suitable condition for the recep- 
tion of this product of conception at any time. It 
is now known that the menstrual flow is not the 
whole of menstruation, and that the changes going 
on in the uterus are almost as continuous as the 
process of digestion. The whole of the reproduc- 
tive life of woman has been divided into cycles of 
twenty-eight days each; these cycles have been di- 
vided into four stages. 

Stages of the Menstrual Cycle. — The first or 
constructive stage is one of preparation for the re- 
ception of the ovum. During this stage the prepar- 
ing of a decidua takes place, or building a nest for 
the expected egg ; there is a swelling of the mucous 
membrane, an enlargement of the uterine glands, 
and an increase in the connective tissue. It is 
thought that this stage lasts for one week; when 
pregnancy does not occur, it is followed by degen- 
erative changes. 

The second or destructive stage is marked by de- 
structive changes which give rise to the usual phe- 



102 Maidenhood. 

nomena of the menstrual period ; t there is a dis- 
charge of blood, mucus, and disintegrated mucous 
membrane. The actively growing cells of the uter- 
ine lining membrane undergo rapid destructive 
changes, the fabric of the half -formed decidua tum- 
bles to pieces, the turgid capillaries burst and pour 
out the menstrual flow, which sweeps away all the 
useless debris. The irritation sets up reflex uterine 
contractions, and so the blood is squeezed out of 
the distended capillaries and washes away the de- 
generated cells. 

The third or reparative stage, as its name indi- 
cates, is one of repair, in which by constructive 
changes the epithelial lining which was thrown off 
is replaced by new, which is formed in from three 
to four days. 

The fourth or quiescent stage includes the re- 
maining twelve or fourteen days of the menstrual 
cycle, and represents the quiescent period prior to 
the initiative changes which mark the beginning of 
the next period. 

Average Duration of the Menstrual Flow. — The 
average duration of the menstrual flow is five days, 
although the variations are considerable in healthy 
women. A flow lasting any place from two to 
six days is perfectly consistent with health; but a 
flow continuing less than two or more than six days 
generally indicates local or general disease. 



Physiology of the Female Generative Organs. 103 

Character of the Menstrual Flow. — For the first 
few hours, or perhaps for the first day, the flow is 
usually slight in quantity and light in color; on 
the second and third days the flow reaches its height, 
and is profuse and dark, but it should never be 
clotted ; after this it gradually ceases. The amount 
of the flow varies from five to ten ounces. If less 
than five or six or more than eighteen napkins are 
pretty well saturated through, the amount may be 
considered abnormal. 

Relation of Ovulation to Menstruation. — It has 
not yet been decided just in what relation the pro- 
cesses of ovulation and menstruation stand to each 
other. It is supposed that the transit of the ovum 
to the uterus occupies at least one week. It has 
been thought that the decidua of a particular men- 
strual period is related, not to the ovum discharged 
at that period, but to the ovum discharged at the 
preceding period. 

The present view is that the influence upon the 
uterus is brought about through the blood, and is 
based upon the very reasonable assumption that the 
ovary elaborates an internal secretion. This view is 
strongly supported by Fraenkel, who believes that 
the internal secretion is furnished by the cells of the 
corpus luteum. He holds that ovulation normally 
occurs two weeks prior to menstruation, and that the 
activity of the lutein cells is responsible for the secre- 



104 Maidenhood. 

tion (hormone) which stimulates the uterine mucosa 
to the growth that takes place during the premen- 
strual period. 

The menstrual wave, or the wave of " supplemen- 
tary nutrition,"* upon which the menstrual process 
ultimately depends, was first established by Dr. 
Mary Putnam Jacobi in the Boylston prize essay 
for 1876; showing that menstrual life is associated 
with a wave of well-marked vital energy, which man- 
ifests itself in a monthly fluctuation of the tempera- 
ture of the body, in the daily amount of the excre- 
tion of urea and of carbonic acid, and of the rate 
and tension of the pulse. The wave attains its 
maximum during the week preceding menstruation, 
and slowly falls to its minimum, which is reached 
the week after menstruation. 

This wave indicates a periodic variation in the 
bodily metabolism, and is probably directly influ- 
enced by the rhythmic activity of the menstrual 
center. This observation would seem to be nullified 
by the fact that the phenomena referred to have been 
found to occur in men as well as in women; and 
that the lower animals also seem to show the same 
periodic variations. " It is therefore evident that 
the phenomena belong not to the function of men- 
struation, but to a general law of vital energy." 

♦Dr. Goodman and Dr. Stephenson have since written 
on this subject, and the "wave" is often known as the 
Stephenson wave. 



Physiology of the Female Generative Organs. 105 

Definition of Menstruation. — Menstruation may, 
then, be defined as the periodic discharge of blood 
from the uterus, accompanied by the shedding of the 
epithelium of the body, as well as that of the uterine 
glands near their orifices. 

The sanguineous discharge is due partly to the 
oozing of blood from the surfaces denuded of epi- 
thelium, and partly to active congestion. The dis- 
charge from the uterus is largely augmented by 
mucus secreted in increased quantity at this period 
from the enlarged uterine glands. 

The tubes take some part in the process of men- 
struation; their mucous membrane is swollen, the 
epithelium is shed in places, and they are filled with 
a thin bloody fluid, containing blood-corpuscles and 
cast-off epithelium cells. 

The menstrual wave continues from puberty to 
the menopause ; it is a nervous phenomenon. Ovu- 
lation is a progressive, non-periodic process ; it be- 
gins before birth and continues till the ovarian tis- 
sue is atrophied or worn out. 

Premonitory Symptoms of the Flow. — The pre- 
monitory symptoms of the monthly flow should not 
be so marked as to cause the individual any dis- 
comfort. The first indication of the return of the 
period should be the appearance of the flow. There 
is generally a feeling of abdominal fulness with 
some lassitude, and sometimes slight headache. The 



106 Maidenhood. 

temperature is lower and the pulseJs slower than at 
other times. This lowered tone of the system is 
an additional reason for increased care against ex- 
posure in wet or cold weather. 

Hygiene of Menstruation. — During the men- 
strual periods all cold baths must be strictly pro- 
hibited, whether tub-baths or cold sponges. The 
reason of this is that the application of cold to the 
surface causes a driving in of the blood from the 
exterior of the body to the internal organs; and 
at the menstrual periods there is already a congested 
condition of the pelvic organs, and it must be re- 
membered that congestion is the first stage of in- 
flammation. 

Hot or warm sponge-baths may be taken through- 
out the period; and the vulva should be bathed 
with warm water twice a day through the entire 
period of the flow, as this not only removes the 
clotted blood before it decomposes and becomes 
the source of irritation, but also removes other irri- 
tating matters, and prevents the nervousness that 
is caused by a local irritation. 

It is strange how women who are scrupulously 
neat in all other respects will allow the smegma to 
collect in and about the vulva; as a matter of fact, 
for the purpose of cleanliness it is much more neces- 
sary that the external genitals should be washed 



Physiology of the Female Generative Organs. 107 

twice a day with soap and water all through life 
than that the face should be washed that often. 

Another question which is still sub judice is the 
necessity for and the frequency with which vaginal 
douches should be taken ; all physicians are agreed 
that a vaginal douche taken immediately after the 
menstrual period is beneficial, as it removes all the 
debris of the flow, which is sometimes very irritat- 
ing. 

Exercise. — A moderate amount of exercise should 
be taken every day; this is needed now quite as 
much as at any other time, and only good can result 
from it. And no harm comes of a woman going 
out in the rain or in cold weather; as has been 
shown, the menstrual process is going on for a large 
part of the time, and the flow is only the external 
appearance, but during the time of the flow the 
woman must be unusually careful not to get her feet 
wet or to sit down with damp clothing on. Violent 
exercise of all kinds is to be prohibited at this time, 
as dancing, rides on the bicycle, gymnastics, and 
walks of over three miles. The reason for this is 
very obvious ; the uterus has now reached the height 
of its turgescence, and is heavier than at any other 
time, hence the danger that displacements or a very 
profuse flow would be caused by any kind of violent 
exercise. 

Treatment. — If the woman has been so unfor- 



108 Maidenhood. 

tunate as to get caught out in a heavy rain so that 
her clothes have been wet through, or if in the cold 
weather .she should come into the house thoroughly 
chilled, the best thing to do is to take off her wet 
things as quickly as possible, be well rubbed down 
with hot, rough towels, drink a cup of hot tea, go 
to bed at once and place a hot-water bag over the 
abdomen. She should remain in bed until the next 
morning, to the end that the circulation may regain 
its equilibrium as quickly as possible by the imme- 
diate relief of the pelvic congestion. If this ex- 
posure should have caused the sudden cessation of 
the flow, a hot mustard foot-bath should be taken. 
One tablespoonful of mustard is used to a gallon 
of water as hot as can be borne; the pail should 
be made as full as can be without running over, and 
a blanket wrapped around the pail and woman, so 
as to cause a profuse perspiration; this should be 
kept up for ten minutes ; if the water cools off, hot 
water may be added. 



CHAPTER VII. 

THE ANOMALIES OF MENSTRUATION. 

Menorrhagia and Metrorrhagia; Dysmenorrhea; 
Amenorrhea; Leucorrhea; Pruritus Vulvce; Fre- 
quency of Pelvic Disorders in Young Women. 

" Defer not till to-morrow to be wise, 
To-morrow's sun on thee may never rise." 

— Congreve. 

Menorrhagia and Metrorrhagia. — By menorrhagia 
is meant an excessive or too profuse menstrual flow ; 
by metrorrhagia, a flow of blood between the men- 
strual periods. Neither one constitutes a disease 
by itself, but is a symptom of some pathologic con- 
dition. 

It has already been stated that the excretory or- 
gans, by constantly eliminating from the system the 
worn-out material, keep the machine healthy and in 
good working order. Kept within natural limits, 
this elimination is the source of strength and health ; 
beyond these limits, the menstrual flow becomes an 
actual hemorrhage that, by draining away the life, 
becomes the source of weakness and disease. 

No physician would dare to bleed a man or 
woman once a month, year in and year out for thirty 

iog 



no Maidenhood. 

years ; but, through ignorance or folly, this is what 
many girls do for themselves. 

This excessive flow, aside from actual local dis- 
ease, is brought about by excessive muscular exer- 
cise during menstruation ; by the use of all stimu- 
lants, whether alcoholic beverages or quinin; as 
well as by the thinness of the blood. 

When the flow is excessive, it must be considered 
a pathologic condition, which needs the physician's 
attention. Rest in the recumbent position is the 
first essential; the diet must be plain and unstimu- 
lating, and attention must be paid to the condition 
of the blood. 

The general diseases which generally cause this 
condition are anemia, Bright's disease, malaria, the 
early stages of tuberculosis, and heart disease. 

The local causes may be reflex, as powerful emo- 
tions; or due to local disease of the uterus and its 
appendages, as the various inflammations and dis- 
placements of the uterus, fibroid tumors, polypi, and 
cancer. 

Dysmenorrhea is painful menstruation. The most 
frequent forms are due to uterine congestion; to 
mechanical causes, as a narrowing of the cervical 
canal, particularly at its internal opening, or to a 
constriction caused by the bending over of the 
uterus at the junction of the body and the neck; 
or to ovarian irritation. 



The Anomalies of Menstruation. in 

The pain varies in intensity from slight discom- 
fort to the most intense uterine colic, which is ex- 
perienced in the lower part of the abdomen. In 
severe cases the general health becomes undermined, 
the nervous system gives way, and hysteria and 
other disorders of the nervous system result. 

The congestive variety usually occurs in patients 
who have previously menstruated painlessly. The 
pain comes on suddenly with the flow and ceases 
when the flow stops; it is very severe and is gen- 
erally accompanied by a diminution or a cessation 
of the flow. There is severe headache, marked 
diminution in the secretion of the kidneys, and gen- 
eral restlessness. The patient frequently experiences 
pain in walking, is easily fatigued, has leucorrhea 
and an irritable bladder. 

In ovarian dysmenorrhea the pain precedes the 
flow for several days and ceases when a free flow 
is established. The pain is of a dull aching charac- 
ter, and may be felt on one or both sides of the 
abdomen, according as one or both ovaries are in- 
volved. 

Amenorrhea. — In amenorrhea the menstrual flow 
may not appear for some years after it is normally 
due; or the flow may cease after some months or 
years of continuance ; or the flow may be abnormally 
scanty or even absent. 

The menstrual flow is much later in appearing in 



ii2 Maidenhood. 

some families than in others, so that this may be 
considered as a family idiosyncrasy ; and if the girl's 
health is good, it need cause no anxiety. If, on the 
contrary, the girl has severe headaches, or suffers 
in any way, the physician should be summoned at 
once, as the absence of menstruation may be indica- 
tive of some serious pathologic condition. 

A scanty flow is often indicative of thinness of 
the blood ; on the other hand, serious anemias often 
lead to profuse menorrhagias or metrorrhagias, as 
has already been stated. The cause of the profound 
anemia itself may be insufficient nutrition, overwork, 
or lack of exercise. 

Scanty menstruation is often seen to occur in 
fevers, in the later stages of consumption, in ad- 
vanced Bright's disease, in malaria, or in any other 
very serious disease. In these cases it seems to 
be a conservative process on the part of nature in 
the run-down state of the system. As consumption 
progresses menstruation generally ceases absolutely, 
never to return again; and in this case nothing 
should be done to try to induce a return of the flow. 

Great shock sometimes causes a sudden cessation 
of the flow; and sometimes a sea- voyage, followed 
by the change of habitat, will cause an obstinate 
form of amenorrhea. 

But it cannot be too well understood that, after 
the menstrual flow has been regularly established, 



The Anomalies of Menstruation. 113 

it continues with the greatest regularity throughout 
the child-bearing period, unless the exposure to wet 
or cold has been sufficiently severe to cause great 
indisposition on the part of the woman. In this 
case it is possible that, if the exposure took place 
just previous to the time of the expected flow, one 
period may remain out. But except in case of se- 
rious illness,— as for example, typhoid fever, — two 
or more periods do not fail to appear except in the 
case of pregnancy. 

Leucorrhea. — Leucorrhea, or " whites," is a mu- 
cous or mucopurulent discharge from the vagina; 
it may be a symptom of uterine or vaginal disease. 

Immediately after the menstrual flow there is a 
well-marked vaginal secretion which is whitish in 
appearance; it may be transparent or of a milky 
color, and is sometimes very acrid. This secretion 
may also precede the flow, and there is nothing 
abnormal in this. But any discharge occurring be- 
tween the periods sufficient to stain the clothing — 
the so-called whites or leucorrhea — is abnormal, 
and is caused by an inflammation of the vagina or 
the neighboring parts. In addition to the discharge 
there is heat and swelling of the parts, more or 
less local distress, and generally intense nervousness. 

If the disease is not cured, it may become chronic. 
The pain, heat, and scalding disappear, but a copious 
discharge continues, and in this stage the disease 
8 



114 Maidenhood. 

may be very obstinate and greatly reduces the 
strength. The constant drain breaks down the sys- 
tem, producing pallor, debility, pain in the back, 
palpitation, indigestion, and so forth. 

The character of the discharge in leucorrhea varies 
considerably, from a whitish or mucous secretion, 
to a yellowish or mucopurulent secretion, and is 
debilitating in proportion "as it is profuse. It is to 
be remembered that this is not in itself a disease, 
but indicates a disease of some of the pelvic organs ; 
and that all such inflammations left to themselves 
incline to grow worse. 

A severe leucorrhea is generally attended with 
frequent and finally painful urination; pain in the 
lower part of the abdomen on walking, which may 
become so severe as to compel the patient to go to 
bed. 

Pruritus Vulvae. — This is an intense and persist- 
ent itching of the vulva, and is a symptom rather 
than a disease. It is not an infrequent result of 
leucorrhea, the acrid discharge of the latter leading 
to an irritation of the parts; this causes rubbing 
of the parts until a veritable inflammation is pro- 
duced. 

Other causes of pruritus vulvae are: The local 
congestion, such as occurs at the menstrual period, 
or in certain cases of pelvic inflammations, or in 
early pregnancy; constipation; sedentary habits; 



The Anomalies of Menstruation. 115 

congestion of the liver; incontinence of urine, and 
diabetes. When dependent on the latter, the malady 
is most obstinate in yielding to treatment. Indi- 
gestible foods or drinks, the rubbing of the clothes, 
the friction of walking, and the heat of the bed act 
as exciting causes in those predisposed to it. 

The essential treatment here is to at once ascertain 
and remove the cause; aids in the treatment are 
vaginal douches and cooling lotions. 

Frequency of Pelvic Disorders in Young Women. — 
From the statistical study made of the physical ex- 
aminations in the case of 160 young women candi- 
dates for the Presbyterian Board of Foreign Missions, 
it is evident that pelvic disorders are much more com- 
mon in young women than has heretofore been sup- 
posed, and are doubtless the cause of the lowered 
vitality and sickness in a correspondingly large class 
of cases. 

To be exact, in only 33 per cent, of all these young 
women were the pelvic organs and functions normal. 
In the remaining 67 per cent, there were displace- 
ments with inflammation of the uterus, accompanied 
in 12 per cent, of the cases by inflammation and dis- 
placements of the ovaries. Such serious pathologic 
conditions were discovered as fibroid tumors, der- 
moid cysts, appendicitis, etc., requiring immediate 
operation. And the fact must be emphasized that 



n6 Maidenhood. 

all of these young women had previously undergone a 
physical examination by their local physicians and 
been recommended to the Board as being physically 
fit for the very hard work and trying climatic con- 
ditions entailed on missionaries going to the foreign 
field. 

It is obvious that no physical examination of a 
woman is complete without a careful pelvic examina- 
tion made by a trained specialist. That these ex- 
aminations should always be made by women physi- 
cians goes without saying, for physical as well as 
psychologic reasons. If, as educators hold, "the 
teachers of sex hygiene should always be of the same 
sex," how much more essential is it in the .matter of 
local examination of the genital organs; there must 
otherwise result a gross injury of their finer sensibili- 
ties and a breaking down of the essential modesty 
and reserve that will always remain the best safe- 
guard of chastity. 



. CHAPTER VIII. 

THE MARRIAGE QUESTION. 

Herbert Spencer's Definition of Love; What Con- 
stitutes a Suitable Husband; Best Age for Mar- 
riage; Shall Cousins Marry? Contraindications 
to Marriage; Do Reformed Profligates Make 
Good Husbands? the Proper Length of Time for 
the Engagement; the Right Time of the Year to 
Marry; the Selection of the Wedding Day. 

"Well, Brutus, thou art noble; yet, I see, 
Thy honourable mettle may be wrought 
From that it is disposed: Therefore, 'tis meet 
That noble minds keep ever with their likes. 
For who so firm that cannot be seduced?" 

— "Julius Casar." 

Herbert Spencer's Definition of Love. — " Love is 
habitually spoken of as though it were a simple 
feeling, whereas it is the most compound, and there- 
fore the most powerful, of all the feelings. Added 
to the purely physical elements of it, are first to be 
noticed those highly complex impressions produced 
by physical beauty; around which are aggregated 
a variety of pleasurable ideas, not themselves ama- 
tory, but which have an oragnized relation to the 
amatory feelings. With this there is united the 
complex sentiment we term affection — a sentiment 

117 



n8 Maidenhood. 

which, as it can exist between those ,of the same sex, 
must be regarded as an independent sentiment, but 
one which is here greatly exalted. Then there is 
the sentiment of admiration, respect, reverence, in 
itself one of considerable power, and which in this 
relation becomes in a high degree active. There 
comes next the feeling called the love of approba- 
tion. To be preferred above all the world, and 
that by the one admired above all others, is to have 
the love of approbation gratified in a degree passing 
every other experience, especially as there is added 
that indirect gratification of it which results from 
the preference being witnessed by others. Further, 
the allied emotion of self-esteem comes into play. 
To have succeeded in gaining such attachment from 
and sway over another is a proof of power which 
cannot fail to agreeably excite amour propre. Yet 
again, the proprietary feeling has its share in the 
general activity. There is the pleasure of possession, 
the two belonging to each other. Once more, the 
relation allows of an extended liberty of action. 
Toward each other a strained behavior is requisite. 
Around each there is a suitable boundary that may 
not be crossed; an individuality on which none 
may trespass. But in this case the barriers are 
thrown down, and the love of unrestrained activity 
is gratified. Finally, there is an exaltation of sym- 
pathies, egotistic pleasures of all kinds are doubled 



The Marriage Question. 119 

by another's sympathetic participation, and the pleas- 
ures of another are added to the egotistic pleasures. 
Thus around the physical feeling forming the nu- 
cleus of the whole, are gathered the feelings pro- 
duced by personal beauty that constitutes simple 
attachments, of self-esteem, of property, of love of 
freedom, of sympathy. These, all greatly exalted 
and severally tending to reflect their excitements 
on one another, unite to form the mental state we 
call love. And as each of them is comprehensive 
of multidinous states of consciousness, we may say 
that this passion fans into immense aggregate most 
of the elementary excitations of which we are capa- 
ble; and that hence results its irresistible power." 

What Constitutes a Suitable Husband. — It is de- 
sirable that the husband shall be a few years older 
than the wife. Man is later in coming to maturity, 
and also retains his sexual powers considerably 
longer than woman; so that for these functions to 
cease about the same time, the wife must be younger 
than the husband. A difference of from two to 
five years is best ; if the parties are young, it is not 
essential that the husband should be much the wife's 
senior, as it is later in life. The husband may be 
ten years older, but a greater disparity of age than 
this is rarely compatible with congeniality of tastes 
and dispositions, so essential to a happy married 
life. The woman who risks her happiness with a 



120 Maidenhood. 

man many years younger than herself violates a 
precept of nature. 

The average stature of the man is about three 
inches greater than that of the woman, and in the 
physiologic marriage any great deviation from this 
should be avoided. 

The essentials for a happy marriage may be 
summed up as follows: that the parties shall be 
of suitable age; that they shall be physically well 
mated and in full sympathy with each other's views 
of life, of the same social position, and of equal 
education. 

The Best Age for Marriage. — The reproductive 
life begins with puberty, but maturity is not reached 
before the age of twenty-one. It is only then that 
the standard of development is reached that is most 
compatible with the successful bearing of the grave 
responsibilities of wifehood and motherhood. The 
too early exercise of the reproductive functions leads 
to increased suffering on the part of the mother, 
depresses her vitality, and increases her liability to 
disease. Statistics show that the mortality is very 
much greater where girls marry under twenty years 
of age. 

The offspring are apt to be small and ill devel- 
oped, and die in large numbers in early life; only 
a small percentage live long and robust lives. In 
France it has been observed that where the fear of 



The Marriage Question. 121 

conscription has caused many young people to marry 
the offspring were lacking in vigor. Among the 
offspring of immature parents there is a larger pro- 
portion of idiots, cripples, criminals, scrofulous, in- 
sane, and tubercular than among the children of 
nubile parents. 

In our climate women are best fitted to become 
wives and mothers between the ages of twenty-four 
and twenty-eight years. Before this age neither 
their self-knowledge, their knowledge of the world, 
nor their experience is sufficiently mature to fit them 
to wisely make the choice of a companion for life, 
or to become mothers. After forty, most women 
cannot hope for children. Men had better wait 
until between the ages of twenty-seven and thirty 
years, before they undertake the responsibilities of 
parenthood. 

Shall Cousins Marry?— They might if both fami- 
lies were perfectly healthy ; but as few families are 
without some lurking predisposition to disease, it 
is not well, as a rule, to run the risk of developing 
this by too repeated unions. 

Contraindications to Marriage. — Young women 
in whose family there is a distinct history of such 
hereditary diseases as cancer, tuberculosis, or insan- 
ity for two generations back, should not marry at 
all. Not only is this a fearful legacy to hand down 
to their children, but pregnancy and child-bearing 



122 Maidenhood. 

very decidedly favor the development of these dis- 
eases. 

Syphilis in either sex is a distinct bar to marriage ; 
first, the party married is sure to contract the dis- 
ease, even though it may have been supposed to 
have been cured. Fortunately, the children of such 
marriages are generally still-born; still, they do 
sometimes live, and are most pitiable and sickly 
objects. For any one to marry under these condi- 
tions is a crime against society, against the State, 
and against posterity. 

Women who have serious forms of heart disease, 
tuberculosis, or Bright's disease would, by becoming 
pregnant, run a serious risk of losing their lives 
toward the close of the pregnancy or at the time of 
their confinement. In case of heart disease, the pul- 
monary congestion that accompanies pregnancy, to- 
gether with the encroachment of the pregnant uterus 
on the cavity of the chest, would greatly add to the 
embarrassment of the hearts action. 

In normal pregnancy there is some congestion of 
the kidneys; where there is actual disease of the 
kidneys prior to the pregnancy, this congestion is 
apt to become so severe as to threaten the woman's 
life. These organic diseases are not to be con- 
founded with functional diseases which are depend- 
ent on some other cause ; as palpitation of the heart 
due to indigestion, or heart murmurs dependent on 



The Marriage Question. 123 

the thin state of the blood, or congestion of the 
kidneys due to exposure to cold ; — all of which 
may be cured by proper treatment. 

Should a woman with a fibroid tumor marry, she 
would run a great risk to her life ; she should have 
the tumor removed, or, if this is not possible, she 
should give up all thoughts of marriage, since the 
increased irritation and congestion consequent upon 
the marital relations would tend to favor its growth. 
Should pregnancy ensue, delivery might be attended 
with serious complications, as very difficult labor, 
postpartum hemorrhage, or, as these tumors have 
but little vitality, and the pressure to which they are 
subjected during labor is liable to cause their death, 
disorganization, sloughing, and, as a result, puer- 
peral septicemia. Death from hemorrhage, following 
the delivery, frequently occurs. 

Sometimes there is such a lack of development 
of the genital organs as to prevent the woman from 
having children. 

Two persons with even a slight tendency to the 
same disease, either inherited or acquired, should not 
intermarry, even if they are in comparatively good 
health at the time. Their offspring would be quite 
sure to inherit their diseased tendencies. 

Persons whose constitutions have been somewhat 
injured, but who are not tainted with actual disease, 
may rear children much healthier than themselves, 
provided their own lives are wisely regulated. If 



124 Maidenhood. 

they are growing better all the time, and are not 
too much broken in constitution, it may be safe for 
them to marry. 

Among the Jews the physician is frequently con- 
sulted before matrimonial alliances are contracted. 
This custom could not but be of universal benefit; 
many local or general diseases would be eradicated 
before marriage, and in this way much suffering 
and unhappiness would be spared ; or, in other cases, 
the patient would be advised of the inadvisability of 
marriage. 

Do Reformed Profligates Make Good Husbands? 
— The manner of life that has been led by this class 
of men is such as to undermine their health, if not 
to have rendered them physical wrecks. There is 
the overindulgence in alcoholic beverages, and per- 
haps, added to this, some drug habit. In addition 
to this, these men early in their career are apt to 
become infected with some of the venereal diseases, 
or perhaps with all of them — gonorrhea, syphilis, 
and so forth; and these diseases have the horrible 
characteristics of becoming latent. A man who con- 
tracts this kind of a disease can never be really sure 
that he is cured. All venereal diseases are highly 
contagious. 

It is now a well-established fact that gonnorrheal 
infection is not only one of the most common causes 
of pelvic inflammations in women, but that these 



The Marriage Question. 125 

same inflammations are of the most virulent types, 
unless they are recognized and treated in the early 
stages. It is also a well-known fact that a large 
percentage of married women suffer from this dis- 
ease. Sterility almost always results. 

In the case of a syphilitic parent, one or two 
children may be born, but the offspring is generally 
sickly and diseased. Inebriety as well as sexual ex- 
cesses"" are both well recognized as distinct forms of 
disease accompanied by degeneracy of brain tissue. 
It is nothing less than criminal for such men to have 
children, since these children would at least inherit 
the tendency to the same diseases, if they did not 
actually have them; there is also a strong proba- 
bility of such children being born idiots or imbeciles. 

It is therefore self-evident that, instead of a re- 
formed profligate making a good husband, he must 
make a very diseased one. It has therefore been 
suggested that the parents of the prospective bride 
should demand from the intended groom a certificate 
of freedom from all venereal diseases by a physician 
of their own selection. Also that there should be 
legislation upon the subject, and that before a man 
is granted a license of marriage, he should have a 
certificate from the health officer of freedom from 
syphilis, gonorrhea, and tuberculosis. 

The Proper Length of Time for the Engagement. 
— A period not shorter than three months, nor 



126 Maidenhood. 

longer than one year, should elapse between the 
engagement and the marriage. 

There are strong physiologic reasons against long 
engagements : they keep the affections and the pas- 
sions in an excited and unnatural condition, which 
after a time tends to weaken the nervous system 
and undermine the health. These evil consequences 
are common to both sexes. It is far better that the 
subject of marriage should not be entertained at all 
unless the circumstances are such that the union 
might with propriety be effected at once. 

The Right Time of the Year to Marry.— When 
woman marries she enters upon a new life, and a 
very trying one. Extreme heat and extreme cold 
are both very taxing to the human economy. Mid- 
summer and midwinter are therefore both objection- 
able, but especially the former. 

The Selection of the Wedding-day. — This is by 
common consent left to the bride. She should select 
a time about ten or fifteen days after the end of one 
of her menstrual periods, as this is the time of com- 
parative sterility, and it is most desirable that the 
first sexual relations should be fruitless. 



PART III -MARRIAGE. 



CHAPTER IX. 

THE ETHICS OF MARRIED LIFE. 

The Wedding Journey; the Ethics of Married 
Life; Shall Husband and Wife Occupy the Same 
Bed? the Consummation of Marriage; the Mari- 
tal Relation; Times when Marital Relations 
Should be Suspended. 

" If it is possible to perfect mankind, the means of doing so will be 
found in the medical sciences." — Descartes. 

The Wedding- journey. — The wedding- journey, 
which was formerly the cause of so much discom- 
fort to both husband and wife, has fortunately gone 
out of vogue; and in its place has come the retire- 
ment to a quiet country or seaside spot, away from 
the prying eyes of friends. Thus the nervous strain 
incident to sight-seeing and travel is avoided. 

The Ethics of Married Life. — It has been said 
that God set men and women in pairs in order 
that they might perfect each other and complete each 
other's happiness. The secret of all true happiness 
in life lies in the spirit of altruism; one must be 

127 



128 Marriage. 

able to wholly forget herself and to find her hap- 
piness in the welfare of others. 

The woman who exhausts herself physically and 
financially on the preparation of her trousseau and 
her wedding does her husband a wrong by bring- 
ing him a wife who is on the verge of nervous 
prostration. 

The secret of a happy married life depends to 
no small extent on the very beginning : the relation 
is so entirely new, and much lies hidden in the 
character of each that was never suspected by the 
other. 

Between husband and wife there must always be 
mutual concessions, forbearance, and sympathy; a 
mutual helpfulness to attain all that is best. This, 
of course, implies that the life of each is an open 
book for the other to read; that there is an un- 
reserved exchange of thought ; and that no privilege 
is claimed by the one that would not willingly be 
accorded to the other. 

" How many men," says Balzac, " proceed with 
women as the monkey of Cassan with the violin; 
they have broken the heart without knowing it, as 
they have tarnished and disdained the jewel whose 
secret they never understood. Almost all men are 
married in ignorance of women and of love. They 
have commenced by forcing open the doors of a 
strange house and have wished to be well received 



The Ethics of Married Life. 129 

in its salon. But the most ordinary artist knows 
that there exists between him and his instrument — 
his instrument which is made of wood or ivory — a 
sort of indefinable friendship. He knows by ex- 
perience that it has taken years to establish this mys- 
terious rapport between an inert material and him- 
self. He could not have divined at the first stroke 
all its resources and caprices, its faults and its vir- 
tues. His instrument only became a soul for him 
and a source of melody after long study; he only 
came to understand it as two friends after the most 
learned interrogation. 

" So the world is full of young women who grow 
pale and feeble, sick and suffering. The ones are a 
prey to inflammations more or less severe ; the others 
remain under the dominion of nervous attacks more 
or less violent. All these husbands have caused 
their own unhappiness and ruin. Never begin mar- 
ried life with a rape. To demand of a young girl 
whom one has seen forty times in fifteen days to 
love you because of the law, the king, and justice is 
an absurdity. 

" Love is the union of necessity and of sentiment. 
Happiness in marriage is the result of perfect un- 
derstanding between the spirits of husband and 
wife. From this it happens that in order to be 
happy, a man is obliged to bind himself to certain 
rules of delicacy and honor. After taking advantage 



130 Marriage. 

of the social laws which consecrate the necessity, 
it is necessary to obey the secret laws of nature, in 
order to make the sentiments flourish. If a man 
places his happiness on being loved, it is necessary 
that he should love sincerely ; nothing resists a veri- 
table passion." 

Shall Husband and Wife Occupy the Same Bed? 
— Among civilized nations custom differs in this 
regard; in Germany, for instance, the husband and 
wife occupy separate beds in the same room; for- 
merly in this country it was almost the universal 
custom for husband and wife to occupy the same 
bed. The current of opinion has changed in this 
respect, and it is now considered in the highest in- 
terests of both that they shall occupy not only sep- 
arate beds, but separate rooms; these rooms com- 
municating through a door which connects their re- 
spective dressing-rooms. This is unquestionably the 
best arrangement from the hygienic as well as from 
the ethical point of view. Health requires that one- 
third of the time shall be spent in sleep ; the bed 
was made for sleep; and the most refreshing sleep 
can only be obtained by occupying the bed alone. 
If two persons occupy the same bed and one is rest- 
less, the sleep of the other is necessarily disturbed. 
Again, two persons occupying the same bed neces- 
sitates the same hour for rising and retiring, which 
is not always convenient or agreeable. Balzac writes 



The Ethics of Married Life. 131 

on this subject : " To put the system of separate 
bed-rooms into practice is to attain to the highest 
degree of intellectual power and of virility. By what 
syllogism man arrived at establishing as a custom 
that of man and wife sleeping together, a practice 
so fatal to happiness, to health, to pleasure, and 
even to self-love, would be curious to seek out." If 
for financial reasons it is not possible to have sepa- 
rate bed-rooms, the German custom of having sep- 
arate beds should be adopted. 

The Consummation of Marriage. — The consum- 
mation of marriage is often attended with difficulty 
owing to the rigidity of the hymen ; this, if present, 
must usually be ruptured before connection takes 
place. Great gentleness and care must be exercised 
by the husband if it does not readily yield, the use 
of hot vaginal injections should be kept up for sev- 
eral weeks before the trial is repeated. These usually 
relax the parts very considerably; but if coitus is 
still found impossible, it is better to consult a physi- 
cian at once, when a simple operation will generally 
remove the trouble and the woman is spared much 
suffering. In no case is any violence on the part 
of the husband allowable, as it might produce ir- 
reparable injuries. 

There is always more or less suffering on the part 
of the wife at first, partly due to the rupture of the 
hymen, and partly to the forcible dilatation of the 



132 Marriage. 

vagina and she should be allowed a sufficient time 
for nature to repair these injuries. By so doing, 
the constitutional disturbances and the nervous dis- 
orders which are so very prevalent may be pre- 
vented. Too frequent indulgence at this period is 
a prolific source of inflammatory diseases, and often 
occasions sterility and ill-health. 

The first nuptial relations should be fruitless, in 
order that any indisposition arising therefrom should 
have had time to disappear before the woman be- 
comes pregnant. 

The Marital Relation. — It is most important for 
the interest of both parties that there should be 
chastity in the marriage relation as well as out of it. 
Many young couples have had their lives ruined by 
excessive sexual indulgence. The effect is usually 
most severe upon the husband, yet the wife becomes 
weak, nervous, and excitable. Sexual excess is also 
the grave of domestic affection. The general rule 
given is that coitus should never take place oftener 
than every seven or ten days. When coitus is suc- 
ceeded by langour, depression, or malaise, it has 
been indulged in too frequently. 

Among civilized people there are three widely 
different views as to the proper course to be pursued : 

First, those who maintain that sexual intercourse 
should not take place except for the propagation 
of the species. 



The Ethics of Married Life. 133 

Second, those who believe that the act is a love 
relation, mutually demanded and enjoyed by both 
sexes, and serving other purposes besides that of 
procreation. 

Third, those who hold that sexual intercourse is 
a physical necessity for the man, but not for the 
woman. 

The first theory, " that the sexual relations should 
never be sustained save for the purpose of procrea- 
tion," has many advocates. They teach that there 
are other uses for the procreative element than the 
generation of offspring, and far better uses than its 
waste in pleasures. They claim that a life of total 
chastity increases the physical and mental vigor; 
and there will result a procreation on the mental 
and spiritual planes, instead of on the physical ones. 

They also claim that to woman belongs the cre- 
ative power; that she must choose when a new life 
shall be evolved ; and that only by adhering to this 
law can she be .protected in the highest function of 
her being — -the function of maternity. 

The adherents of the second theory, " that the act 
is a love relation, mutually demanded and enjoyed 
by both sexes, and that it serves other purposes be- 
sides that of procreation," claim that the female 
sexual life indicates that the healthy woman is 
neither indifferent nor passive in the generative act. 
It has much the same effect as in man — a powerful 



134 Marriage. 

increase in her sensations, whole groups of muscles 
are set in motion, and the uterus as well as the 
entire nervous system are in an excited condition 
and activity. And that it is the province of the 
mother to decide when a new life should begin. 

The third theory, " that sexual intercourse is a 
physical necessity for the man, but not for the 
woman," is by far the most widely accepted. We 
will consider, first, the practical results of this last 
theory; and, second, the scientific basis on which 
it rests. 

It is generally acknowledged that this practice 
has done more to cause domestic misery, sickness, 
and death than that dreadful scourge of the human 
race, tuberculosis. 

This man, accustomed all his life to gratify his 
sexual passions promisculously, marries a virtuous 
young girl. In her menstrual periods she has had 
to do only with the secondary phenomena; with 
the expulsion of the ova not at all. She has had 
no instruction in the corresponding physiologic life 
of the man, and is astonished at the male sexual 
indications, and is led to believe in their physiologic 
necessities. The result is that she not only suffers 
physically, but feels outraged and disgraced. She 
is liable to the chance of maternity at any time; 
and such offspring will probably be sickly. 



The Ethics of Married Life. 135 

Passion is presented to the young wife in so 
hideous a guise that it will take the utmost con- 
sideration of her husband afterward to enable her 
to completely overcome her repugnance. If she be 
worn and weary of excesses in the early days of 
her married life, the husband will have only him- 
self to blame if he is bound all his life to an apa- 
thetic and irresponsive wife. Husbands place great 
strains upon the affections of their wives, and lower 
themselves almost past reinstatement in their respect 
and esteem. 

Lastly, on what scientific basis does this " physi- 
logic necessity " for sexual gratification on the part 
of the male rest? Analogy with the lower animals 
does not bear it out. Among animals, except in 
rare instances under domestication, the female ad- 
mits the male in sexual embrace only for procrea- 
tion. Among many savage tribes this same rule 
has but few exceptions. The analogies between the 
male and the female sexual organs ; between seminal 
emissions and menstruation ; between the sexual life 
of the male and of the female, only go to accentuate 
the fact that this so-called physiologic necessity on 
the part of the male has arisen chiefly through the 
difference of education; so that it has come to be 
that the woman is chaste and the man is degraded ; 
that the woman is too sentimental and the man too 



136 Marriage. 

passionate. From a purely medical standpoint, the 
most eminent physicians and physiologists of the 
day all unite in advocating a chaste and continent 
life, simply for the sake of the man's own health, 
independently of all other considerations. 

Times when Marital Relations Should be Sus- 
pended. — The marital relations should always be 
suspended during the menstrual period. During 
pregnancy intercourse should never, or at least very 
rarely, be indulged in. At this time the mother 
needs to conserve all her strength and energies for 
herself and child; and any sexual relations during 
this time increase the sufferings of the mother and 
impair the vitality of the child. It has been even 
suggested that much of the pain during parturition 
would be avoided by entire continence during preg- 
nancy. Intercourse during the early months of 
pregnancy is a frequent cause of abortion. Women 
who have supposed that they have never been preg- 
nant have in reality been having abortions every 
second or third month. It is especially important 
that intercourse should not take place during the 
last month of pregnancy because of the great danger 
of septic infection. 

A woman should never be subjected to coitus 
until three months after delivery. During lactation 
intercourse should never, or at least very rarely, be 



•< 



The Ethics of Married Life. 137 

indulged in; as the function of lactation makes a 
heavy drain on the strength of the mother, and any- 
thing which would further weaken her would tend 
to impoverish the quality of the milk and thus the 
child would suffer. 



r 



CHAPTER X. 

SEXUAL INSTINCT IN WOMEN. 

Sexual Instinct in Women; Excessive Coitus; 
Causes of Sexual Excitability. 

" Virtue, the strength and beauty of the soul, 
Is the best gift of heaven." 

— Armstrong. 

Sexual Instinct in Women. — After careful ob- 
servation of the sexes in the married state, it is 
found that the sexual appetence is less in women 
than it is in men. Much of this difference in sexual 
appetence is doubtless due to the chastity of their 
lives, coupled with and resulting from the difference 
of education. The girl is taught repression, and 
the boy expression ; that girls must be chaste ; that 
chastity for boys is impossible. 

According to the intensity of the sexual instinct 
women have been divided into three classes: A 
larger number than is supposed have little or no 
sexual feeling. Second, those who are subject to 
strong passion; this class is larger than the first, 
but small as compared with the whole of their sex. 
Third, those in whom the sexual appetite is mod- 

138 



Sexual Instinct in Women 139 

erate; this class comprises the vast majority of 
women. 

And, even granting to woman more pleasure in 
sexual indulgence than usually comes to her by 
largest allowance, it is safe to say that in nine cases 
out of ten maternity, with its early pains and later 
cares, greatly lessens her power of enjoyment; and 
that for the larger part of her married life she is 
either positively distressed by the apparently neces- 
sary demands of her husband upon her, and irre- 
sponsive to them, or kept to a cheerful response by 
a self-abnegation and regard for his comfort, not to 
say fear of his moral aberration, which is a positive 
drain upon her health and strength. 

Excessive Coitus. — Those who are most fre- 
quently found to suffer from venereal excesses are 
the newly married; especially if they have weak 
constitutions and excitable temperaments. A great 
deal of mischief is done by two persons of unequal 
constitutions being matched together; the husband 
may exhaust the wife or vice versa, the weaker 
party being constantly tempted to exceed his 
strength. In all sexual matters there must be a 
consideration for others. It is not so much from 
selfishness as from ignorance that such a mistake 
is made. The ignorance comes from a lamentable 
morbid delicacy which prevails on all sexual mat- 
ters, and which prevents all open and rational con- 



140 Marriage. 

versation on them, even between- those who have 
the most intimate knowledge of each other. 

When the conjugal act is repeated too often, the 
man will become gradually conscious of diminished 
strength, diminished nerve force, and diminished 
mental powers. Excess weakens a man's energies, 
and enervates and effeminates him. Moreover, it 
renders him liable to an infinity of diseases and a 
readier victim to death. 

Not only is the strength of the constitution low- 
ered by the excessive expenditure of force and mat- 
ter requisite for the perpetuation of the species, but 
this lowered standard of vitality is transmitted to 
children. There can be but little doubt that this is 
one of the reasons why so many healthy parents 
beget sickly children, who die early. They have 
exhausted themselves of the material from which a 
new life is created, and so it is not properly started 
at the beginning and never reaches its highest devel- 
opment. To the truth of this statement attests the 
mental imbecility, the pallid and attenuated forms, 
of the children who are the earlier products of mar- 
riage. The effect of excessive coitus in women is 
seen by the confirmed ill health of so many women 
after marriage and repeated child-bearing. A large 
number of these cases are dependent upon alteration 
and diseases of the genitalia; but a considerable 
number are unconnected with local disease, and in 



Sexual Instinct in Women 141 

many other cases the health is never regained after 
all local phenomena have disappeared. 

Sexual excitement in the woman causes certain 
congestion of the genital organs ; and at the time of 
the orgasm there is a reflex movement which cor- 
responds to erection, and which consists of a peri- 
staltic movement of the tubes and uterus; to the 
uterus also is ascribed an act of suction by which 
the spermatozoa are drawn up into its interior. 
Even when pregnancy does not follow, the too fre- 
quent excitation and activity of the uterus in weak 
constitutions causes illness, first of the genital or- 
gans and then of the nervous system. 

Local diseases caused in women by excessive coi- 
tus are : vaginal catarrh, acute catarrh of the vulva, 
acute inflammation of the lining membrane of the 
uterus as well as of the uterus itself, inflammation 
of the ovaries, and even peritonitis. It is also known 
to be an important factor in the origin of blood- 
tumors and of cancer of the uterus. Especially is 
coitus at a time of great physical fatigue liable to 
be provocative of uterine inflammations. Aside 
from ethical considerations, coitus during the men- 
strual period may be the cause of rupture of the 
impaired blood-vessels, thus causing blood-tumors. 
Excessive coitus is a well-known cause of chronic 
inflammation of the uterus ; that is, a habitual con- 
gestion of the uterus is induced by excessive sexual 



142 Marriage. 

intercourse. This has been frequently mentioned 
by authors as leading to enlargement of the uterus 
in the non-pregnant condition ; and it is a still more 
potent factor in the recently impregnated organ, 
whose tissues are succulent and the vessels enlarged, 
a condition inviting congestion and enhancing the 
susceptibility to engorgement. 

The general manifestations of impaired health 
in women due to excessive coitus are : chronic ane- 
mia, with malnutrition; impaired and altered func- 
tions in all the organs, especially those of the nerv- 
ous system. Menorrhagia is apt to be induced by 
overstimulation of the ovaries, together with ex- 
haustion and sexual apathy. 

The source of so much misery is the increasing 
physical weakness of the female and the increasing 
nervous weakness of the male, with an increasing 
sexual excitability, two factors of tragic effect for 
the wife. Here is seen the unfortunate result of 
teaching two kinds of morals, one for men and 
another for women. 

Causes of Sexual Excitability. — Too frequent 
genital irritation, onanism, too frequent intercourse, 
alcohol, too rich and too highly seasoned foods, lack 
of exercise. 

Treatment of Sexual Excitability. — Avoid alcohol 
and precocious puberty. Strictest attention must 
be paid to the diet; everything is to be avoided 



Sexual Instinct in Women 143 

which is difficult of digestion or which retards it. 
The following articles of diet must all be avoided: 
cheese, foods seasoned with pepper and curry, highly 
salted and acid foods, and all rich foods ; and meat 
must be eaten only in moderate quantities. Con- 
stipation irritates the genitalia directly and increases 
the inflammation. The close relation of Venus and 
Bacchus is known not only in mythology. Car- 
bonated waters are to be especially avoided, such 
as soda, seltzers, Preblauer, Geisshubler, and acid 
waters; also champagne and beer, heavy Italian, 
Spanish, and English wines. All alcoholic drinks 
must be forbidden. 

As heavy gymnastics as the strength of the indi- 
vidual will admit, and plenty of exercise out-of- 
doors must be taken. There must also be constant 
mental and physical employment. In women sexual 
excitability is often caused by local diseases, and 
passes off with their cure ; if not, she must use her 
will-power, and take the various forms of cold baths. 
Sexual intercourse not oftener than once in two 
or three weeks, and avoid all intimate approaches; 
if this is not sufficient, she will have to leave her 
husband for a few months. 



CHAPTER XI. 



STERILITY, 



Sterility; the Prevention of Conception and the 
Limitation of Offspring; the Crime of Abortion; 
Infidelity in Women. 

" Never let yourselves do evil that good may come. If you do, yov 
hinder the coming of the real, the perfect good in its due time." 

— Philips Brooks, 

Sterility. — Conception is least apt to take place 
from the tenth day after one period until the third 
day before the next ; but there is practically no time 
during a woman's sexual life when she may not be 
impregnated; in this connection it must be remem- 
bered that the spermatozoa stay alive in her for 
more than a week. 

During lactation women are generally sterile, es- 
pecially in the first months which follow the ac- 
couchement, because the vital forces are then concen- 
trated on the secretion of milk. 

The age of the wife at the time of marriage has 
much to do with the expectation of children. As 

144 



Sterility. 145 

the age increases over twenty-five years the interval 
between the marriage and the birth of the first child 
is lengthened. For it has been ascertained that not 
only are women most fecund between twenty and 
twenty-five years, but that they begin their career 
of child-bearing sooner after marriage than either 
their younger or older sisters. 

A wife who has had children and ceases to con- 
ceive for three years will probably bear no more. 

When marriages are fruitless, the wife is almost 
always blamed ; but it is by no means the wife that 
is always at fault; many husbands are absolutely 
sterile. Every man is not prolific who enjoys good 
health and is vigorous. Gross states that in one 
case out of six the sterility was due to the male. 
Kehrer, after a series of carefully conducted experi- 
ments, has arrived at the conclusion that in at least 
a third of the cases of sterile marriages the husband 
was the party at fault, and that gonorrhea was the 
cause of the barrenness. 

Venereal diseases have their share of influence, 
and the gonorrheal infection is a potent cause of 
sterility. It is by no means proved that syphilis has 
any unfavorable influence on conception, though 
abortions due to this are frequent. 

Gonorrhea often prevents conception by the in- 
flammation traveling up the womb, and along the 

Fallopian tubes to the ovaries, whose covering is 
10 



146 Marriage. 

rendered thick and dense, so that the ovum cannot 
escape, or if it does, the fimbriated end of the tube 
is so agglutinated that it cannot grasp the ovum. 

Alcoholism is considered a cause of sterility. It 
evidently does diminish the sexual potency in the 
male, and for this the female is often blamed. 

It does not follow because a woman has not given 
birth to a child that she has not conceived. The 
life of an infant for a long time after birth is a 
frail one, and before birth its existence is extremely 
precarious; it often perishes a few days after con- 
ception. A period coming on a few days late, and 
at the same time one which is unusually profuse, 
is the only evidence which the young wife may 
have of an abortion. Among prostitutes, the fre- 
quent delay of menstruation, then abundant hem- 
orrhage, is in many cases only habitual abortion, 
and leads to changes in the generative organs which 
must result in sterility. A tendency to miscarriage 
may therefore be all that stands in the way of hav- 
ing a family; this can frequently be remedied. 

Sexual incompatibility is well known to exist; 
prominent examples being Augustus and Livia; 
Napoleon and Josephine. It is also a well-known 
fact that frigidity is a cause of barrenness. A short 
separation of husband and wife is often salutary in 
its influence upon fertility. 

It is a well-established fact that the time imme- 



Sterility. 147 

diately before the period, but still more that imme- 
diately following the period, are the most favorable 
times for conception to take place; the remaining 
quiet in bed of the woman after the generative act 
is also favorable to conception. 

The most frequent causes of sterility in women 
are inflammation of the lining membrane of the 
uterus, or of the neck of the uterus, or of both. 
The source of this condition in women who have 
had children is most frequently due to parturition 
or abortion. In the newly married it may be due 
to a previously existing slight uterine catarrh in a 
displaced uterus, or it may be a manifestation of a 
run-down state of the system. In a majority of the 
newly married, however, the inflammation of the 
endometrium is probably due to the first efforts at 
conjugal approach. Many young women as the 
result of the preparation of the trosseau, augmented 
by a round of gaities at the time of marriage, enter 
the married state in a condition bordering on phy- 
sical and nervous exhaustion; and then begin en- 
gorgements and inflammations which lead to future 
suffering and to sterility. Displacements and flex- 
ions of the uterus also cause sterility. Such dis- 
placements of the neck of the uterus may occur 
that, instead of lying in a pool of semen, as it should, 
it is above, in front of, or away from it, and this 
may prevent conception. 



T48 Marriage. 

Vulvar and vaginal hyperesthesia, inflammations 
of the vulva, undue shortness of the vagina, unless 
great care is exercised by the husband, will induce 
painful coitus, and may bring about sterility by 
favoring the formation of a copulation sac outside 
of the axis of the uterine canal, and consequently 
misdirection of the semen. 

Scrofula, probably by its effects on the general 
condition, leading to deficient development of the 
whole body, the genital organs included, may be 
productive of sterility. 

The female being less passionate than the male, 
the orgasm comes on later with her, or the male 
orgasm occurs so soon that she may not reach that 
stage at all. If both were simultaneous, it is rea- 
sonable to suppose that conception would be more 
likely to occur. 

Ovulation is doubtless more frequently performed 
in some women than in others. Some women con- 
ceive with more or less regularity every fifteen or 
eighteen months, and others at intervals of several 
years. 

The effect of repeated coition, provided that im- 
pregnation does not take place at once, is to engorge 
the uterine vessels, to alter the nature of the glandu- 
lar secretions, to cause profound reflex disturbances, 
and thus to produce such changes in the endome- 
trium as to lead to local inflammation and to general 



Sterility. 149 

nervous exhaustion. Backache, leucorrhea, and irri- 
table bladder are the first symptoms of this disorder ; 
but frequently there are added to these, headache, 
indigestion, rectal tenesmus, painful and profuse 
menstruation. In many cases the disease continues 
in a mild catarrhal form, giving the woman little 
inconvenience besides the slight leucorrheal dis- 
charge which stains her clothing; but often this is 
indicative of such a change of the lining membrane 
of the uterus as to render it unfit for the fixation 
and development of the ovum, even should impreg- 
nation take place. 

Under normal conditions, during the intermen- 
strual period, a plug of clear viscid mucus, which is 
secreted by the glands of the cervical canal, blocks 
up that passage, but is washed away each month by 
the menstrual discharge. Under ordinary conditions 
this obstruction must seriously interfere with the 
entrance of the spermatozoa into the cavity of the 
uterus, and renders the former theory, recently 
revived by Bossi, quite tenable, that impregnation 
is most likely to occur just after the menstrual 
epoch. 

The vaginal secretion under certain pathologic 
conditions may become so acid that it induces ster- 
ility. Women who suffer from severe vaginal ca- 
tarrh are frequently sterile, the spermatozoa being 
found dead in the vagina some hours after copula- 



15° Marriage. 

tion, although an examination a shorter time after- 
ward revealed them still alive. Incases where con- 
ception takes place in spite of a very acid condition 
of the vaginal secretion, it is probable that some 
of the spermatozoa enter the uterus before the secre- 
tion has had time to act on them, or possibly the 
spermatozoa being injected in a mass, the acid secre- 
tion is unable to penetrate and kill them all. 

The reaction of the normal vaginal mucus is 
always acid, that of the cervix alkaline; but as the 
result of the inflammatory condition, the reaction 
of each is often intensified, especially that of the 
vagina, which has an exceedingly sour and pene- 
trating odor. This acid discharge, bathing the neck 
of the uterus, penetrates more or less into the cer- 
vical plug and causes coagulation of the alkaline 
mucus. 

The chief constituent of the semen is albumin; 
agents which affect albuminous substances influence 
the functional activity of the spermatozoa — heat, 
concentrated acids, and probably concentrated alka- 
lies. In normal conditions the alkalinity of the 
seminal fluid seems to be sufficient to neutralize the 
acidity of the vaginal secretions, so that the sperma- 
tozoa may remain seventeen days or more (Bossi) 
within the vaginal canal, even during a menstrual 
period, without having their vitality destroyed. 

When hyperacidity of the vaginal secretion is 






Sterility. I5 1 

present, it is probable that the fertilizing element 
is at once rendered inert; but should some of the 
spermatozoa succeed in reaching the interior of the 
cervical canal, the increased alkalinity of the secre- 
tion there would in all probability put an end to 
all further progress. 

The conditions, then, which appear to prevent 
fecundation are: First, the absence of the proper 
nidus for the ovum; second, the obstruction of the 
cervical canal by a mucus plug; third, increased 
alkalinity of the cervical secretion, often accom- 
panied by the increased acidity of the vaginal secre- 
tion. Three conditions must, then, be determined: 
First, are there spermatozoa in the semen ? Second, 
do they get into the uterocervical canal? Third, 
do the secretions in the canal poison the sperma- 
tozoa ? 

" For those who are very anxious for offspring, * 
wrote Marion Sims, " I usually order sexual inter- 
course on the third, fifth, and seventh days after the 
flow has ceased; and on the fifth and third days 
before its return. For the most obvious reasons 
this would always be before going to bed at night, 
instead of just before rising in the morning. The 
horizontal position favors the retention of semen; 
the erect its expulsion. I am satisfied that too fre- 
quent sexual indulgence is fraught with mischief 
to both parties. It weakens the semen; in other 



152 Marriage. 

words, that this is not so rich in spermatozoa after 
too frequent indulgence; and when carried to the 
extent of a debauch, the fluid ejaculated may be 
wholly destitute of spermatozoa. Thus it will be 
seen that it will be much better to husband the re- 
sources of both man and wife." 

The Prevention of Conception and the Limita- 
tion of Offspring. — Some of the contraindications to 
procreation are when either parent suffers from a 
disease which is transmissible, and such diseases 
frequently manifest themselves only after marriage; 
when the pregnancy would endanger the mother's 
life, or even where the pregnancy is a nine months' 
torture to her ; where either parent is suffering from 
ill health ; or where for economical reasons no more 
children are desired. 

If there exists no condition in either parent or in 
their circumstances why they should not have chil- 
dren, the next consideration due to their children, 
is how the same may be procreated under the most 
favorable conditions possible ; this condition can only 
be secured by making the circumtsances such that 
the mother shall be able to choose the time for their 
conception when both parents are in the best phy- 
sical condition. That children should be brought 
into the world haphazard, as the result of accident, 
is to degrade the human race below that of the lower 
animals, where the female admits the male only at 



Sterility. 153 

the time of the rut, which in the majority of cases 
occurs only once a year. 

Another requisite to bearing healthy children is 
that the pregnancies shall not follow each other too 
rapidly. Aside from the consideration for the health 
of the mother herself, she must be in good physical 
condition to bear the healthiest children she is capa- 
ble of giving birth to; and for this there must be 
from two and a half to three years between the 
successive pregnancies. The results of overproduc- 
tion on the children are frequently, that they are 
sickly, short-lived, or suffer from rickets, cerebral 
paralysis, idiocy, or imbecility. 

And last, but certainly not least, many women 
become chronic invalids, or are hastened to pre- 
mature graves, by having children as fast as they 
possibly can. 

The most natural and moral way for the artificial 
prevention of conception, when on account of ill 
health or for economic reasons no more children 
are desired, is to abstain from sexual intercourse. 
But in the majority of cases the husband will not 
agree to this, and so the greatest number of methods 
have come to be used to prevent conception. 

Perhaps the most frequent method use to prevent 
conception is withdrawal before the ejaculation of 
semen. While this is most injurious to the husband 
— debility, nervous prostration, and even paralysis 




154 Marriage. 

are said to ensue — the health of the wife also suf- 
fers. If this interrupted sexual congress is con- 
tinued for years, there develop gradual nervous dis- 
turbances on both sides, and a serious disease of the 
uterus makes itself felt. The generative organs 
become engorged with blood, but are not permitted 
to enjoy relaxation consequent upon the full comple- 
tion of the act. This engorgement may lead to 
undue local nutrition, and diffuse growth and pro- 
liferation of the connective tissue may take place. 
Hence the uterine walls become dense and thickened 
and the nerves compressed. Of course, pain and 
tenderness and a sense of bearing down will be the 
result. Flexions and versions may be consequent 
upon the engorgement. The nerves become shat- 
tered, and the woman will be fortunate if she con- 
tracts no serious womb trouble. 

" It is strange," says John Stuart Mill, " that in- 
temperance in drink or any other appetite, should 
be condemned so readily, but that incontinence in 
this respect should always meet not only with indul- 
gence, but with praise. Little improvement can be 
expected in morality until the producing of too large 
families is regarded with the same feeling as drunk- 
enness, or any other physical excess." 

Sismondi writes : " When our true duties toward 
those whom we give life are not obscured in the 
name of a sacred authority, no man will have more 



Sterility. x 55 

children than he can properly bring up. If a woman 
has a right to decide any question it is how many 
children she should bear. Whenever it becomes 
unwise that the family should be increased, justice 
and humanity require that the husband should im- 
pose on himself the same restraint which is sub- 
mitted to by the unmarried." 

In the opinion of Dr. Edward Reich, it is very 
much to be wished that the function of conception 
should be placed under the domain of the will. 

But the strongest appeal has been made for the 
sake of morality itself; namely, to prevent the 
crime of abortion. Dr. Raciborski, of Paris, took 
the position that the prevention of offspring to a 
certain extent is not only legitimate, but it is to be 
recommended as a means of public good. 

Continence, self-control, and a willingness to deny 
himself — that is what is required of the husband. 
But suffering women assure us that this will not 
suffice; that men refuse to restrain themselves; 
that it leads to loss of domestic happiness, to ille- 
gitimate amours; or that it is injurious physically 
and mentally; that, in short, such advice is useless 
because it is impracticable. 

Dr. Napheys writes : " Is it amiss to hope that 
science will find resources, simple and certain, which 
will enable a woman to let reason and sound judg- 



156 Marriage. 

ment, not blind passions, control the increase of her 
family?" 

The Crime of Abortion. — From the moment of 
conception a new life begins, a new individual exists ; 
another child is added to the family. The mother 
who deliberately sets about to destroy this life by 
want of care, or by taking drugs, or by the use of 
instruments, commits a great crime, and is just as 
guilty as if she strangled her new-born infant. The 
crime she commits is child-murder. Women in their 
frenzy at finding themselves in this condition, and 
with no slightest idea of the sin that they are com* 
mitting, are constantly guilty of committing abor- 
tions on themselves, or going to professional abor- 
tionists to have this crime of child-murder com- 
mitted. This is another of the sins due to the ignor- 
ance of the sex in all matters pertaining to repro- 
duction ; and it is a fearfully prevalent one. 

Infidelity in Women. — " We have now reached 
the last infernal circle of the divine comedy of mar- 
riage; we are at the depths of the inferno. There 
is something, I do not know what, terrible in the 
situation in which a married woman finds herself 
when an illegitimate love has ruined her for the 
duties of a wife and mother. As has been so well 
and strongly expressed by Diderot, infidelity in 
woman is like incredulity in a priest; it is the last 



Sterility. 157 

step in human forfeitures; it is for her the great 
social crime, for it implies all the others. 

" Weigh the sufferings of the future, the agonies 
of years by the ecstasy of half an hour. If this 
conservative sentiment of the creature, the fear of 
death, does not stop her, what could be expected 
of laws ? Oh, sublime infamy I " — ( Balzac) . 



PART IV -MATERNITY. 



CHAPTER XII. 

s 

PREGNANCY, 

Nature of Conception; Pregnancy Defined; Dura- 
iion of Pregnancy; the Signs of Pregnancy; 
Quickening; the Determination of Sex at Will; 
the Influence of the Male Sexual Element on the 
Female Organism; Heredity; Hygiene of Preg- 
nancy; Causes of Miscarriage. 

" Happy he 
With such a mother, faith in womankind 
Beats with his bood, and trust in all things high 
Comes easy to him, and though he trip and fall, 
He shall not bind his soul with clay." 

— Tennyson. 

Nature of Conception. — Conception, or impregna- 
tion, is the union of the germ and the sperm cell, 
the result of which is a new being. On coition, the 
semen being received into the female organs, which 
are at that time in a state of turgescence, the sperma- 
tozoa, by means of their own vibratile activity, find 
their way into the Fallopian tubes, and here come 
in contact with the ovule. 

158 



Pregnancy. i59 

The ovule is a minute cell with a transparent 

membrane, within which is the yolk containing the 
germinal vesicle. The spermatozoon penerates into 
the ovule and becomes fused with it. The processes 
of development begin at once to occur. There is 
congestion of the uterine mucous membrane out of 
proportion to the rest of the uterus ; the ovum finds 
lodging here, and becomes surrounded by a mem- 
brane which incloses it in a separate sac. 

Pregnancy Defined. — Pregnancy begins with con- 
ception and ends with parturition; it provides for 
the nutrition and the expulsion of the embryo and 
for its nutrition for a short time after birth. 

The average duration of pregnancy is ten lunar 
months, or two hundred and eighty days. The 
date of the confinement is calculated by reckoning 
from the date of the last menstrual flow; count 
backward three months from the date of the first 
appearance of the last menses; to this add twelve 
months and seven days, five days being for the 
average menstrual duration and two days for the 
possibility of fecundation. 

Duration of Pregnancy.— Many difficulties are ex- 
perienced in determining the date of the expected 
confinement. As most pregnancies occur in married 
women, we cannot base any calculations on a single 
act of coitus. And even if there was but one, all 
physiologists agree that there is a variable period 



y 



160 Maternity. 

in different women, and in the same woman at dif- 
ferent times, between insemination and the fertiliza- 
tion of the ovum. It is the moment of fecundation, 
or the union of the germ and sperm cells, which 
marks the beginning of pregnancy. The uncer- 
tainty becomes still greater owing to our inadequate 
knowledge as to the length of time during which 
the sexual elements, the ova and the spermatozoa, 
retain their vitality after liberation from their re- 
spective sources. While it is not certainly known, 
it is probable that the ovum is capable of impreg- 
nation any time during its sojourn within the ovi- 
duct and before reaching the uterus, or probably for 
a period of about one week from the time of its 
escape from the Graafian follicle. The remarkable 
vitality of the spermatozoa even under less favor- 
able circumstances — direct observation shows that 
these elements retain their movements for over nine 
days outside of the body — renders it almost cer- 
tain that their powers of fertilization are maintained 
for a long time after they are deposited within the 
healthy female genital tract; it is believed that the 
spermatozoa are capable of fertilization after a so- 
journ of three or more weeks within the oviduct. 

Consideration of these facts renders apparent the 
impossibility of fixing with certainty the date of 
the beginning of pregnancy, since conception may 
result from the union oi the ovum liberated at the 



Pregnancy. 161 

beginning of the period with the spermatozoon in- 
troduced at the end of that time; or it may result 
from the meeting of the male elements already 
within the oviduct with an ovum discharged a day 
or two before the occurrence of the menstrual period. 

The Signs of Pregnancy. — The cessation of the 
menstrual period is the sign of the greatest value 
in women who have been regular; but it must 
always be remembered that there may be an irregu- 
larity of menstruation for the first few months after 
marriage. The appetite is capricious; morning 
sickness or nausea in the morning on first getting 
up is a very common symptom in the early months 
of pregnancy; enlargement of the abdomen; in 
the first two months of pregnancy the abdomen is 
flattened and the umbilicu s is depressed ; after this 
the abdomen begins to enlarge. There is also an 
increase in the size of the breasts, with a deepened 
color of their areolae and later a watery secretion. 
The external genitals become swollen and of a 
bluish color. Feeling of the fetal movements — 
that is, the movements of the small parts of the 
child in the womb — by the mother is not always 
reliable, since gas in the intestines has sometimes 
been mistaken for this. These signs are more val- 
uable when several exist together. 

The nausea and vomiting of pregnancy, the so- 
called morning sickness, consists of nausea accom- 
ii 



1 62 Maternity. 

panied often by vomiting or retching of a glairy 
fluid, showing itself most frequently on rising in 
the morning, but sometimes appearing after break- 
fast. It is aggravated by the assumption of the 
erect position. It may begin within a few days, 
but as a rule it does not show itself until the fourth 
week of pregnancy; and it generally ceases about 
the fourth month, rarely persisting throughout the 
entire time. In the majority of cases it does not 
sensibly impair the health. It is a sympathetic dis- 
order reflected from the uterus; it is aggravated 
by indigestible food, by sexual excitement, and by 
emotional disturbances; it is most marked in first 
pregnancies and in women of highly emotional na- 
tures. It is not infrequently due to some inflam- 
mation of the uterus or erosion about the external 
orifice, and disappears on the removal of the cause. 

Mammary Changes. — During pregnancy the 
mammary glands are in immediate sympathy with 
the growing reproductive organs of the pelvis ; con- 
sequently a genuine physiologic enlargement com- 
mences in these organs from the beginning of ges- 
tation. Their glandular structure becomes larger, 
fuller, and firmer ; a sensation of weight or pricking 
is felt by the patient ; the veins become more prom- 
inent. The nipples also become enlarged, more 
elongated, and somewhat erect. Surrounding the 
nipple is the areola; this becomes darker in color. 



Pregnancy. 163 

In most women a drop of watery fluid, the so-called 
colostrum, may be squeezed out from the nipple at 
the end of the third month of pregnancy. 

The signs of pregnancy are divided into the pre- 
sumptive, the probable, and the positive The pre- 
sumptive signs are : menstrual suppression, morning 
sickness, irritable bladder, mental and emotional 
phenomena. The probable sigs are: mammary 
changes, abdominal enlargement, changes in the 
neck of the womb, and certain changes which are 
felt on bimanual examination. The positive signs 
are: feeling the various parts of the fetus, active 
movements of the fetus, and hearing the fetal heart 
sounds. 

Functional disturbances of the bladder are quite 
often noticeable in the early part of the pregnancy. 
In the first part of the pregnancy the bladder is 
dragged upon, and later is is pressed upon by the en- 
larged uterus so that the bladder capacity is lessened 
and frequency of urination is the result. In the fourth 
month, when the uterus ascends into the abdominal 
cavity, these bladder symptoms subside, until the 
very close of the pregnancy, when by the descent 
of the now greatly enlarged uterus there may be 
even incontinence of urine. 

Changes in the Abdomen. — During the first two 
months of the pregnancy there is a flattening of the 
abdominal surface, due to the descent of the uterus 




164 Maternity. 

into the pelvic cavity, thus slightly dragging the 
bladder downward and drawing the umbilicus in- 
ward. In the latter part of the fourth month there 
is noticeable a slight abdominal enlargement, and 
the umbilicus is no longer sunken. By the end of 
the fourth month the base of the uterus has risen 
two inches above the symphysis, and at the end 
of the thirty-eighth week it touches the lower ex- 
tremity of the breast-bone; the umbilicus has been 
for many weeks protruding; during the last two 
weeks of pregnancy the uterus again descends and 
the woman feels more comfortable. 

On the inspection of the abdomen of a pregnant 
woman there will be noticed a brown line which 
extends from the umbilicus to the pubes, and all 
over the surface the presence of striae, or long purple 
grooves, due to the distention of the abdomen; on 
the sides of the abdomen and down the thighs, red, 
blue, or white markings, like cicatrices, may be seen. 

Quickening. — Quickening is the sensation expe- 
rienced by the mother as the result of the active 
fetal movements of the child in the womb. These 
movements are first felt between the eighteenth and 
the twentieth week ; the common rule is that quick- 
ening occurs at the middle of pregnancy; that is, 
at four and a half months. As pregnancy advances 
these active motions increase in frequency and be- 
come more marked. When felt or seen by the 



Pregnancy. 165 

physician, as can be done in the sixth month, fetal 
movements constitute a positive sign of pregnancy. 

The Determination of Sex at Will. — Although 
this has always been a question of great interest, 
and the subject of much experimentation, no rule 
can as yet be given by which the parents can know 
in advance of the birth of the child what the sex 
will be. Dr. Schenck's theory is that the ruling 
factor in determining the sex is the food partaken 
of by the mother. 

Fiirst believes that the differentiation may occur 
before, during, and a little while after the impreg- 
nation ; that the chances of the development of one 
or another sex in one and the same woman may 
vary before final differentiation occurs. It is im- 
possible to determine the sex of the embryo before 
the tenth week of fetal life. The cause of the dif- 
ferentiation, he believes, lies largely in the good 
or bad state of the health of the parents; in the 
first instance there being an excess of females, and 
in the latter an excess of males, relatively speaking. 
He believes that there is an excess of male children 
when conception takes place during the post-men- 
strual anemia. He has investigated one hundred 
and ninety-three cases carefully in regard to the 
probable date of conception after menstruation, and 
there is a notable increase of male births over female 
in the cases where conception occurred in the first 



1 66 Maternity. 

five days after menstruation; that is to say, where 
the woman is not so well nourished as later. 

Dr. J. Griffith Davis gives as the result of her 
experiments in this direction, that when conception 
takes place three days before the menstrual period 
or within forty-eight hours afterward, the child 
will be a girl; when conception takes place ten 
days after the period, the child will be a boy. 

Although there are a greater number of the 
female than the male sex in all parts of the world 
where reliable statistics have been taken, in all civil- 
ized countries the proportion of male births is 
greater than that of females. There is a greater 
tendency of the male offspring to die earlier, and 
this is seen even before birth, in the proportion of 
three to two. For this reason the stronger sex as 
applied to men has been regarded by some authors 
as a misnomer. They are physically weaker in 
early life and succumb more readily to noxious 
influences. 

The relative age of the parents is said to be an- 
other factor in determining the sex of the children. 
Seniority on the father's side gives an excess of 
male children; equality in the age of the parents 
gives a slight preponderance of females; seniority 
on the mother's side gives an excess of females. 
Men, and especially scholars, who pass a sedentary 
life and who exhaust their nervous force to a great 



Pregnancy. 167 

extent, beget more girls than boys ; so, also, a very 
advanced age on the part of the man diminishes the 
number of male offspring. 

The Influence of the Male Sexual Element on the 
Female Organism. — Dr. Alexander Harvey, of Ab- 
erdeen, has adopted the theory of fetal inoculation. 
He believes that the effect is first due to the influence 
of the male element upon the ovum, which, in con- 
sequence of the subsequent close attachment and 
freely inter-communicating blood-vessels between 
the modified embryo and the mother, inoculates the 
condition of the mother with the qualities of the 
male; and so, on the subsequent impregnation by 
another male, the offspring resembles the first male 
and not its real parent. He even goes further, and 
says that it is conceivable, by successive impregna- 
tions effected by him, that the influence may be 
increased, and if so the younger children begotten 
by him, rather than the elder, might be expected, 
ceteris paribus, to bear their father's image. And 
as regards the mother, he suggests the question, 
whether there is not something in the popular notion 
that in the course of years the wife comes to re- 
semble the husband ; and that not merely in respect 
of temper, disposition, or habits of thought, but in 
bodily appearance, which may be referable to this 
influence exerted by the husband on her constitu- 
tion, through the medium of the fetuses in utero. 



1 68 Maternity. 



Yet it shall be; thou shalt lower to his level day by day, 

What is fine within thee growing coarse to sympathize with clay. 

As the husband is the wife is; thou art mated with a clown, 
And the grossness of his nature will have weight to drag thee down. 

He will hold thee, when his passion shall have spent its novel force, 
Something better than his dog, a little dearer than his horse." 



Darwin, on the other hand, considers it a most 
improbable hypothesis that the mere blood of one 
individual should affect the reproductive organs of 
another individual in such a manner as to affect the 
subsequent offspring. The analogy, he says, from 
the direct action of the foreign pollen on the ovaries 
and seed coats of the mother plant strongly supports 
the belief that the male element acts directly on the 
reproductive organs of the female, and not through 
the intervention of the crossed embryo. 

Dr. John Brown, in reviewing the subject, says 
it must be conceded that the male element has an 
influence on the female, over and above its fertiliz- 
ing influence upon the ovum. The limit of this 
influence is at present unknown. 

Heredity. — Girls are more apt to resemble their 
fathers in mental traits, disposition, and constitu- 
tion; while boys take after their mothers. Boys 
procreated by intelligent mothers will be intelligent ; 
while it does not always follow that the sons of 
intelligent fathers are intelligent. The poets Burns. 
Ben Johnson, Gcethe, Walter Scott, Byron, and 



Pregnancy. 169 

Lamartine were all born of women remarkable for 
vivacity and brilliance of language. 

Hygiene of Pregnancy. — The health and perfec- 
tion of the child depend largely upon the health 
and perfection of the parents at the time of its con- 
ception, as well as upon the condition of the mother 
during the pregnancy. Even when both parents 
possess a strong constitution, but one or both of 
them is suffering from a temporary exhaustion or 
malaise, the child will be born below the standard 
of health it ought to possess. Children born during 
the first year of married life seldom equal in health 
the children born of the same parents later; they 
are not only apt to be sickly, but the liability to 
premature death is greatly increased. For this 
reason it is better that the first year of married life 
should be allowed to pass without conception taking 
place. A child begotten in an intoxicated or de- 
praved condition of a parent may be depraved itself 
in the same way, and is apt to be feeble-minded or 
idiotic. 

It must be borne in mind that prenatal culture 
of some sort begins at the time of conception ; and 
that on the mental as well as on the physical state 
of the mother, the health as well as the disposition 
of the child will depend to no slight extent. The 
prospective mother who constantly gives way to 
her feelings does a wrong to her unborn child. The 



170 Maternity. 

mother is at this time more impressionable, more 
nervous, and more irritable than is natural to her; 
and while her family should make a certain allow- 
ance for her condition, she, on her~part, should not 
allow herself to give way to her morbid feelings. 
The prospective mother should not lead a life of 
self-indulgence, on the one hand, or, on the other, 
should not be weighed down with cares ; she should 
interest herself in her usual duties, and be relieved 
of all anxiety possible. 

Dress. — The clothing must be loose, and all com- 
pression about the waist and abdomen must be es- 
pecially avoided. For the ordinary corsets, which are 
injurious at this time, should be substituted maternity 
corsets; these are made with four sets of lacings, in 
the back, front, and at both sides, and the only steels 
are one soft pair in the back. They should be care- 
fully fitted so as to give support to the abdomen, and 
by means of the lacings they can be let out as much 
as may be necessary. A number of excellent makes 
are on the market. 

A woolen undersuit, or undervest and drawers, 
with high neck and long sleeves, must be worn win- 
ter and summer, the grade of the wool to be adapted 
to the season of the year. The especial necessity 
for wearing wool next the skin during the preg- 
nancy is because of the initimate relation between 
the skin and the kidneys. Any chilling of the body 



Pregnancy. 171 

at this time is apt to lead to the congestion of the 
kidneys. If there is already any congestion of the 
kidneys present, or any abdominal pain, in addition 
to the undersuit an abdominal bandage should be 
worn. These bandages come woven in ribbed 
woolen, and fit the body snugly. This bandage 
is to be constantly worn, and, of course, changed 
at night. During the cold weather the stockings 
should also be of wool. Under no circumstances 
are garters allowed to be worn, as they form a 
constriction around the leg and interfere with the 
return of the venous blood to the heart, and so 
increase the tendency to the formation of the vari- 
cose veins. It is better not to use any means to 
hold the stockings up ; they will be kept sufficiently 
well in place by the under-drawers. Low shoes 
should never be worn except in the hottest weather. 
It is of the greatest importance that the woman 
should be impressed with the necessity of the avoid- 
ance of taking cold, since any lung or kidney trouble 
is a serious complication of pregnancy. 

Diet. — The diet is the same as that at any other l/^ 
time, only it is more necessary to guard against 
anything which is likely to cause indigestion. In 
other words, the diet should be plain, simple, and 
easy of digestion; nutritious and partaken of at 
regular intervals. In the latter part of pregnancy 
owing to the pressure of the enlarged uterus on the 



172 Maternity. 

stomach, the food may have to be partaken of in 
smaller quantities and at s horter in tervals. At this 
time also the appetite is abnormally large. Where 
it does not disagree with the patient, milk is the 
best adjuvant possible to the diet. 

Constipation. — Constipation is the rule of preg- 
nancy. This is due to the great pressure that the 
enlarged uterus makes on the bowel; and as im- 
portant as it is at all times to keep the bowels regu- 
lar, it is at this time more necessary than ever that 
the woman should have the bowels well evacuated 
every day. A retention of fecal matter in the body 
causes the reabsorption into the blood of the toxic 
matters, with the resulting headaches, dizziness, loss 
of appetite, and intense nervousness. To obviate 
this tendency to constipation, plenty of fruit and 
vegetables should be eaten, as well as cereals if the 
woman is taking a good deal of outdoor exercise, 
otherwise the latter had better be omitted. The 
woman should drink plenty of water — at least three 
pints a day; this acts as a laxative as well as to 
flush out the kidneys. If, in spite of all these meas- 
ures, constipation still persists, as it probably will, 
a seidlitz powder can be taken the first thing on 
rising in the morning; or from one teaspoonful to 
one tablespoon ful of the effervescing granules of the 
phosphate of soda in a glass of water, also to be 
taken on rising in the morning; or one-half grain 






Pregnancy. 173 

of the solid extract of cascara sagrada night and 
morning. The object of these is to keep the bowels 
open, but purgation must always be avoided. 

Bladder Symptoms. — If there is any irritability 
of the bladder, any scalding on urination, or a very 
great frequency of emptying the bladder in the early 
months of pregnancy, a physician should be con- 
sulted at once; in the last months of pregnancy 
there is a desire to evacuate the bladder frequently, 
and sometimes at the last there is an incontinence 
of urine, which is due to the descent of the uterus 
and the great pressure on the bladder; this con- 
dition disappears with the confinement. 

Leucorrhea. — If this is present to any marked 
degree, the vaginal douche should be continued 
throughout the pregnancy; the temperature of the 
douche should be from no to 112 F. ; it must 
never be taken very hot or very cold. The fountain 
syringe should be used, and the bag should not be 
hung more than three feet above the bed, so that 
there shall not be too much force to the stream of 
water. Except by special direction of the attending 
physician, all douches must be stopped one month 
before the confinement because of the danger of septic 
infection. 

Baths. — Warm tub-baths may be taken through- l^ 
out the pregnancy, but never oftener than twice 
a week, and the woman should never stay in the tub 
longer than is absolutely necessary for the bath, 



174 Maternity. 

as otherwise the bath is too enervating. A daily 
sponge-bath of cool or cold salt water at a tempera- 
ture of from 8o° to 70 ° F., and in the proportion 
of a pint of rock or sea salt to a gallon of water is 
most invigorating, and counteracts many of the 
nervous symptoms and promotes sleep and good 
digestion. The temperature of the room in which 
this bath is taken should be J2° F. Shower-baths 
cause too great a shock to the nervous system, and 
they as well as foot-baths must be prohibited. Sitz- 
baths at a temperature from no° to 90 F. may be 
taken just before retiring throughout the pregnancy. 
The frequency and duration of the bath as well as 
the temperature should be regulated by the attend- 
ing physician. In cases of intense nervousness and 
insomnia these baths have an excellent sedative 
effect. A pregnant woman must never under any 
circumstances take ocean baths, since there is always 
great danger that the shock of the waves will cause 
an abortion. Sea-voyages should be avoided be- 
cause of the severe nausea and vomiting, as well 
as the danger that the lurching of the vessel may 
cause miscarriage. 

The sewing-machine is a tabooed thing for the 
pregnant woman, because of the jarring of the pel- 
vis which it produces. Sweeping of heavy carpets 
is also injurious. There must be no lifting of 
heavy pieces of furniture, and especially no lifting 



Pregnancy. 175 

from the floor, as it interferes with the circulation 
in the uterus and is apt to produce miscarriage. 

Driving in an easy carriage over smooth roads 
is permissible, also short automobile rides; dogcarts 
or any conveyance which produces much jolting must 
be avoided; and, while driving is good, the woman 
should not do her own driving on account of the 
danger of the jars that would be caused by the 
sudden pulling of the horse upon the lines. Horse- 
back-riding and bicycling are, of course, forbidden, 
as are also golf, tennis, and dancing. 

Exercise. — Exercise in the open air should be 
taken every day, when the weather is suitable, and 
walking is the best form of exercise. The amount 
will be regulated to some extent by what the woman 
has been accustomed to taking, and it should always 
stop short of fatigue. The woman should live as 
much as possible in the open air, and she should 
attend to her ordinary duties about the house. Long 
railway journeys are always objectionable. 

Hemorrhoids or piles are very often troublesome 
toward the close of the pregnancy. To overcome 
this, the patient should lie down immediately after 
the bowel movement, and remain in the recumbent 
position for ten or fifteen minutes. In addition, 
care should be taken to secure a loose movement 
of the bowels. Should the piles come down, appli- 
cations of cloths wrung out of hot water, and held 



176 Maternity. 

well pressed against the bowel, should be made; 
the piles should then be pressed back until the finger 
feels that the mass has been pushed above the second 
constriction of the bowel, which is felt to exist at 
about two inches above the sphincter ani muscle. 
Should these means not suffice, the physician must 
be consulted at once. 

Swelling and pain of the external genitals and 
of the lower limbs are best relieved by the recum- 
bent position. Should the veins of the legs be much 
enlarged or the feet swollen, the patient should have 
compression made by the wearing of elastic stock- 
ings. Or in some cases a bandage is sufficient; in 
this case the bandage may be made of muslin; it 
should be three inches wide, and, beginning at the 
toes, should extend up as high as the enlargement 
of the veins continues. This bandage should be 
freshly applied every morning before rising. 

Pain caused by the stretching of, the skin may be 
relieved by the inunction of the skin with cotton- 
seed or cocoanut oil. For severe pain in the small 
of the back, rubbing with soap liniment or alcohol 
will be found useful. 

Mental Occupation. — Important as this always is, 
it is doubly so now. The mind should be constantly 
and pleasantly occupied, but no severe study should 
be indulged in. The emotional susceptibility is gen- 
erally somewhat increased. The pregnant woman, 



Pregnancy. 177 

quite excitable and irritable, readily responds to 
influences by which in the non-gravid condition she 
could not be affected. Sometimes she feels unusu- 
ally well, is intellectually brightened and more 
active, and says she is positively happier. At other 
times she is despondent and morose. 

Physiologists admit and observation proves that 
maternal emotions do affect the development and 
the exterior of the fetus; likewise the mental or- 
ganization of the fetus may be affected. All un- 
pleasant news, frights, and physical shocks, also 
scenes of suffering and distress, must be avoided, 
as the mind is particularly impressionable at this 
time. Around the patient should be thrown a 
gentle and protective care, and she should be treated 
with the considerate kindness which her condition 
demands. Theatres and all places where there will 
be a large assemblage of people should be avoided, 
as the close air and general bad ventilation are apt 
to produce vertigo and sometimes attacks of faint- 
ing. 

Sleep. — During pregnancy a large amount of 
sleep is required ; there should be eight hours spent 
in sleep at night, and one hour every afternoon. 
Pregnant women should never do any night watch- 
ing. There is unusual necessity for good ventila- 
tion during sleep at this time. 

The Marital Relation. — Coitus is, as a rule, dis- 
12 




178 Maternity. 

tasteful to pregnant women. It is for the best in- 
terest of the wife as well as for that of the child that 
all marital relation should be suspended at this time. 
Even uncivilized nations have condemned the privi- 
lege of sexual intercourse during pregnancy, and 
have visited punishment on the offender. If these 
relations are not wholly suspended, they must at 
least be at those periods which correspond to the 
time at which the woman would have been unwell 
had she not been pregnant. To the continuance of 
these relations throughout the pregnancy is due 
much of the suffering of the wife, not only then, 
but at the time of the labor as well ; and the nour- 
ishment of the child is interfered with. 

Causes of Miscarriage.— Hemorrhoids; strain- 
ing at stool; excessive intercourse in the newly 
married; nursing; ocean-bathing; overexertion; 
overexcitement ; a fall ; any violent emotion ; anger ; 
sudden or excessive joy; a fright; running; danc- 
ing; horseback-riding; riding in a heavily built 
carriage over rough roads; great fatigue; lifting 
heavy weights; the abuse of purgative medicines; 
disease or displacements of the womb; and a gen- 
eral condition of ill health. 

The danger of miscarriage is greatest during the 
first three months of pregnancy, especially at the 
time the monthly period would recur. Miscarriage is 
a fruitful source of disease and often of danger to 



Pregnancy. 179 

wives; it is said that thirty-seven out of every hun- 
dred pregnant women miscarry. Miscarriage is 
most apt to occur during the first pregnancy; and 
great care should be taken to prevent this, as the 
habit is easily established, and after one miscarriage 
has occurred, another is likely to follow, so that it 
is sometimes with the greatest difficulty that the 
woman can be made to carry the fetus to full term. 
Artificially produced abortions are not an infrequent 
cause of sterility; the young wife becomes preg- 
nant, and has an abortion produced because she is 
not yet ready to give up all her pleasures; and 
eventually when she does become very anxious to 
have a child such an extent of uterine disease has 
been produced by the abortions that she cannot 
conceive. 

To Prevent Miscarriage. — The life must be free 
from all excitement, and must be as quiet as possible 
without becoming monotonous; especial care must 
be exercised at the return of the dates for the men- 
strual periods. 

The symptoms of miscarriage are a show of blood, 
more or less profuse, with intense abdominal pain; 
on the slightest show of blood the patient should 
go to bed at once and the physician should be sent 
for. 



CHAPTER XIII. 

THE CONFINEMENT. 

Preparation for the Confinement ; Signs of Ap- 
proaching Labor; Symptoms of Actual Labor; the 
Confinement-bed; the Process of Labor, 

" To my conception one generation of educated mothers would do 
more for the regeneration of the race than all other human agencies 
combined; and it is an instruction of the head they need, and not 
of the heart. The doctrine of responsibility has been ground into 
Christian mothers above what they are able to bear." 

— IsABELLE BEECHER HOOKER. 

Preparations for the Confinement. — The right 
time to engage the physician who is to take charge 
of the woman at her confinement is just so soon as 
the woman knows that she is pregnant. It used 
to be argued that, since giving birth to children 
was a physiologic process, there was no necessity 
for the woman to consult the physician until he 
was sent for when the labor pains began. Take 
the case of the woman who is for the first time 
pregnant ; she is absolutely at sea ; she has not the 
least idea how she ought to feel, what she ought to 
do or to leave undone; the result is that she often 
has a miscarriage which is the source of the greatest 

1 80 



The Confinement. 181 

disappointment to her husband and herself, or she 
suffers very unnecessarily throughout the entire 
pregnancy, has a difficult labor, and perhaps gives 
birth to a sickly child. 

The educated physician will explain to her what 
symptoms are normal and what are pathologic, and 
often he will be able to entirely cure the latter. It 
is now a well-established fact that the most serious 
complications of the pergnancy, and of the labor 
itself are caused by severe congestion or disease of 
the kidneys. The condition of the kidneys can only 
be determined by frequent examinations of the 
urine; during the early months of pregnancy these 
examinations are made once a month, and during 
the last month they are made every week. The 
amount of urine passed in the normal condition is 
three pints a day. 

Nowhere, perhaps, is the constant vigilance of 
the physician so well rewarded as in the careful 
oversight of the pregnant woman. She goes through 
her entire pregnancy feeling well, and often the 
greatest discomfort that she suffers is due to her 
size; her labor and her lying-in are normal, and 
she gives birth to a healthy child. 

Engagement of the Nurse. — This is generally left 
to the physician in charge of the case, since he is 
responsible for the safe delivery of the woman ; but 
\f the patient has any decided choice in the matter, 



182 Maternity. 

it is acceded to unless there should be some very 
valid objections, and the physician always sends the 
nurse in view for that case to see the patient in order 
to ascertain if she is personally agreeable to the 
patient. 

Choice of Room for the Confinement and Lying- 
in. — The room should be light, sunny, and well 
ventilated ; it should not be too near a water-closet. 
In the city as quiet a room as possible should be 
selected, and one that is well removed from the 
rest of the house, so that if necessary perfect quiet 
can be maintained. The room should be as cheery 
as possible. 

The dress of the mother during the lying-in con- 
sists of a merino undervest, with high neck and 
long sleeves, and a nightgown, which shall be open 
all the way down the front. The gowns should 
be made of light muslin or of cambric; and there 
should be a sufficient number so that they may be 
changed every day. 

Six abdominal bandages should be provided. 
These are made of light muslin, and they should 
be eighteen inches wide and long enough to go once 
and a third around the patient's hips at the sixth 
month of pregnancy, or about one yard and a quar- 
ter long; they may be made straight or to fit the 
patient at the sixth month. This bandage is fas- 
tened down the front ; it is applied directly after the 



The Confinement. 183 

labor, and adds greatly to the patient's comfort 
during the lying-in. 

The vulvar pads used during the lying-in are the 
antiseptic absorbent pads which can be obtained 
at any place where surgical dressings are sold ; they 
are made of absorbent cotton, covered with cheese- 
cloth, and sterilized. 

There must be a sufficiently generous supply of 
sheets so that they can be changed every day, and 
the drawsheet as often as may be required. Noth- 
ing is so important to a good lying-in as to have a 
clean, well-ventilated room, and plenty of fresh bed- 
linen. Cleanliness is the first requisite to antisepsis, 
and this is the secret of avoiding puerperal fever. 

Articles to be provided for the confinement are: 

1. An oblong douche-pan of agate-ware. 

2. An agate bed-pan. 

3. A bath thermometer. 

4. Two pieces of rubber sheeting; one, one 
yard square, and the other two yards square. 

5. Two sterilized bed-pads, 30 inches square 
by 3 to 4 inches thick. 

6. Three dozen antiseptic absorbent pads. 

7. One pound of sterilized absorbent cotton; 
twelve yards of cheese-cloth. 

8. Six abdominal bandages, eighteen inches 
wide, preferably made to fit the figure at the sixth 
month of gestation. 



184 Maternity. 

9. Two hand-scrubs. 

10. Four ounces of the tincture of green soap. 
n. Bottle of corrosive sublimate tablets. 

12. Four ounces of powdered boric acid. 

13. One bottle of lysol. 

14. Two ounces of aromatic spirits of ammonia. 

15. Two ounces of aqua ammonia. 

16. One pint of alcohol. 

17. Two tubes of sterilized petrolatum; 1 tube of 
K-Y lubricating jelly. 

18. Plenty of large and small safety-pins. 

19. Hot- water bag. 

20. New fountain syringe, to hold four quarts; 
with glass nozle. 

21. One small basin for vomited matter. 

22. Two very large agate basins or wash-bowls 
for washing doctor's hands and for antiseptic solu- 
tions. 

23. Vessel for after-birth. 

24. Three large pitchers; one for boiling water, 
one for cold boiled water, and one for antiseptic 
solution. 

25. Tumbler for boric acid solution for washing 
baby's eyes, with fine old linen sterilized. 

26. One dozen freshly laundered sheets, and two 
dozen towels. 

2J. Stocking-drawers, muslin. 
28. Change of night-clothing warmed for the 
mother. 



The Confinement. I ^5 

29. A warm blanket to receive the baby. 

30. An infant bath-tub. 

31. A large piece of oil-cloth to protect the floor.* 
Baby's. Outfit. — Four flannel bandages, to be 

made of fine, soft flannel, four inches wide, to go 
once and a third around the body. The edges may 
be pinked or whipped, but should never be hemmed ; 
a tape is sewed on double, the ends passing around 
the body, and so the bandage is fastened without 
pinning. 

Six merino shirts, with high neck and long sleeves, 
made to button down the front. 

Cotton diaper napkins, not too large; old soft 
ones are preferable. 

Long merino stockings which can be pinned to 
the napkin. 

Flannel petticoats, not too long, which should go 
over the shoulders. The essential in all the clothing 
is that it should be sufficiently loose. 

Dress-slips should not be so elaborate that they 
cannot be washed and changed with sufficient fre- 
quency; and not so long that the baby's feet will 
be hampered in their movements by them. All of 

* Van Horn & Sawtell, 15 East 40th Street, New York, keep an 
obstetric outfit, containing many of the above articles, cleansed, 
sterilized, and packed in a box ready for use, so that they remain 
intact until needed. The price of this outfit is $19.50. 



1 86 Maternity. 

baby's clothes but the dress should be fastened by 
safety-pins. 

Baby's basket should contain : - 
i. One outfit of clothes. 

2. One tube of sterilized tape. 

3. A pair of blunt-pointed scissors. 

4. Large and small safety-pins. 

5. Pieces of fine old linen; old handkerchiefs 
are the best. 

6. A soft hair-brush. 

7. A powder box and puff, with talcum pow- 
der. 

8. Two tubes of sterilized white vaselin. 

9. Two soft towels. 

10. Castile soap. 

11. Single-bulb syringe; so-called "eye and ear 
syringe." 

12. A woolen shawl or wrap. 

If there is no nurse available before the labor 
sets in, and it is necessary for the patient to see 
to the sterilizing of the above articles, she should 
first scrub off all pitchers, basins, and other utensils, 
as well as the douche-pan, fountain syringe, and 
rubber sheeting, with a brush and hot soap-suds; 
the hand-scrubs are to be well washed; then each 
article should be pinned separately in coarse towels, 
and put to boil for half an hour in an ordinary 



The Confinement. 187 

wash-boiler. The articles so boiled are then dried 
without removing the towels, put away, and not 
opened till the time of the labor. 

The abdominal bandages must be laundried and 
pinned up in separate towels until they are needed. 
The cheese-cloth must be laundried and then ster- 
ilized. 

The vulvar pads should be pinned in an old nap- 
kin, in packages of half a dozen each; and one 
package is sterilized at a time by placing it in the 
oven until the outer covering is scorched. The 
linen for the baby's eyes and the cheese-cloth are 
treated in the same way; they are to be cut up into 
small pieces and sterilized as needed. 

Signs of Approaching Labor. — About two weeks 
before labor there is a sinking of the womb. At 
the beginning of the ninth lunar month this was at 
the end of the breast-bone; it now descends to a 
point midway between this and the navel; the ab- 
domen becomes smaller, the pressure on the lungs 
is relieved, and the woman breathes more freely. 
But at the same time that the woman is relieved 
of the pressure on the chest, she experiences increase 
of the troubles in the lower extremities. There is 
an increase of the bladder symptoms, with a desire 
for frequent unrination. Constipation becomes more 
troublesome, and there may be hemorrhoids; the 



1 88 Maternity 

veins of the lower extremities may become greatly 
enlarged. 

There is an increased fullness" of the external 
genitals and a greatly augmented amount of mucous 
discharge. There is a feeling of anxiety and nerv- 
ousness, with depression of spirits. 

During the last two weeks of pregnancy patients 
are apt to have cramp-like pains in the lower part 
of the abdomen. These are often mistaken for 
labor pains. True labor pains are characterized by 
starting in the back, extending around the abdomen 
and toward the pubes and down the thighs; they 
come at more or less regular intervals of half to 
three-quarters of an hour, and increase in intensity 
with a decrease in the intervals. A strong pain is 
apt to be followed by two weaker ones. The so- 
called false pains are irregular in their occurrence. 

Symptoms of Actual Labor.— First is generally 
the show ; this is a discharge of mucous tinged with 
blood ; at the same time the true labor pains set in. 
When the patient or nurse is in any doubt as to 
the character of the pains, or when the show ap- 
pears, the physician should be summoned at once. 
Other symptoms are frequent desire to empty the 
bladder and bowels, and a sensation of shivering. 

The Confinement-Bed. — A single bed is much 
more convenient, but it is rarely found in a private 
house. The double bed is arranged as follows: 



The Confinement. 189 

The hair mattress is covered with a large rubber 
sheet, which is pinned with safety-pins at the cor- 
ners and tucked well under the mattress ; the rubber 
sheet must not be drawn too tightly for fear of 
tearing. Over this comes the sheet, and over the 
upper half of the bed, the draw-sheet; this is a 
sheet folded four double, which goes across the bed 
so as to come under the hips of the patient, and is 
■tucked under the mattress at both sides. The ob- 
ject of this is so that it may be frequently and easily 
changed without disturbing the patient. The sheet, 
blanket, and spread which are to serve as a covering 
after delivery are folded back and placed on the left 
side of the bed. 

The lower right-hand corner of the bed — the 
right side of the bed is that side which is toward 
the right hand as one stands facing the foot-board 
— is arranged for the confinement ; on this is fas- 
tened the smaller rubber sheet, and over this the 
sheet is folded, and both are fastened down with 
safety-pins. The pillow for the patient should be 
placed at the upper and inner corner of the square. 
After the delivery the patient is lifted to the upper 
part of the bed and the temporary dressing is re- 
moved. A sheet and blanket are used for a cover- 
ing during the confinement. 

Before the labor begins it is well to fasten up 
the vest and gown, so that they will not be soiled, 



i go Maternity. 

as it is important that the patient shall be moved 
as little as possible after the labor, as all movements 
tend to increase the bleeding. 

The floor oilcloth must be spread at the side of 
the bed which is made up for the confinement, and 
should extend slightly under the bed. 

A bureau in the room should contain the mother's 
and baby's clothing, bed-linen, towels, and any other 
articles which will be needed, all properly arranged. 

The clothing for the mother and baby will be 
placed where it will keep warm, and the infant bath- 
tub will be in readiness in case of sudden need 
for it. 

All water used about the confinement must have 
been carefully sterilized in advance. The best way 
to sterilize the water is by boiling it in a large 
wash-boiler; whatever vessel is used must be scru- 
pulously clean, and ought to be new. The vessel 
is covered over, and the water is allowed to boil 
for half an hour; it is then, still covered, set aside 
to cool. There should be three gallons each of 
sterilized hot and cold water; since in case of an 
emergency there must be plenty of water ready 
for use. 

The various articles ordered in the confinement 
outfit will be at hand ready for use. It is the duty 
of the nurse to have everything ready for the doctor 
before his arrival. The patient should have a full 



The Confinement. 191 

warm tub-bath, fresh night-clothes put on, and an 
enema should be at once given to unload the bowels, 
and this even though there may have been a bowel 
movement only a few hours previously. The patient 
should remain in bed until the arrival of the doctor. 
After an examination has assured the latter that all 
is right, she may be allowed to go around the room, 
with a wrapper thrown on over the night-gown. 

Conveniently near the bed should be a small table, 
covered with one or two freshly laundried towels. 
This table should have on it a wash-basin, a hand- 
brush, soap and hot water, an antiseptic solution, 
scissors, a ligature for the navel, and a suitable 
aseptic lubricant for the hands. 

The Process of Labor. — The process of labor is 
divided into three stages. The first stage is that 
of dilatation; by which is meant the stretching of 
the mouth of the womb so that the child may pass 
through. At the first confinement this stage lasts 
about fifteen hours ; at subsequent labors the length 
of this stage is much shorter, the average time 
being eight hours. The pains during this stage 
are sharp and cutting, and they are accompanied 
by a slight show of blood. The patient is fretful 
and nervous 

The second stage of labor is called that of ex- 
pulsion, because in this stage the uterus contracts 
down together with the abdominal muscles to expel 



i9 2 Maternity. 

the child from the womb and the vagina into the 
world. The duration of this stage in the first con- 
finement is about an hour and a half. 

The third stage of labor includes the time from 
the expulsion of the child till the coming away of 
the after-birth; the average length of this stage is 
from twenty minutes to half an hour. 

The average length of time for the first labor is 
seventeen hours; and for subsequent labors from 
eight to eleven hours. 

The bag of waters is the sac of membranes in 
which the child is inclosed. It contains a liquid in 
which the child floats; the object of the water is 
to protect the child from sudden shocks or any kind 
of injury during pregnancy. During labor this 
membrane with its contained water serves as a di- 
lating wedge to assist in the opening of the womb, 
and it also protects the child from the direct con- 
traction of the uterus upon it. When the waters 
break prematurely, the labor is much longer and 
more tedious ; normally this should not occur before 
the mouth of the womb is fully dilated. 

The pains of the second stage of labor are of a 
bearing down character, and constantly increase in 
force and frequency; the climax being reached as 
the head passes through the vulvar orifice. 

A child usually lies in the womb with the head 
downward; the reason of this is that there is more 



The Confinement. 193 

room in the upper part of the uterus, and as the 
small parts of the child as it is folded upon itself 
take up the most space, they occupy this position, 
while the head lies just above the pubes. The 
normal position of the child is : the head is flexed 
on the chest, the legs on the thighs and the thighs 
on the abdomen, and the hands are folded across 
the chest. And so the child is usually born head 
first. 

During the stage of expulsion the head of the 
child is forced down slightly during each pain, to 
recede a little during the intervals between the pains ; 
in this way the vagina and its external orifice are 
gradually stretched so that the head of the child 
may pass through without tearing the parts. If 
the head is allowed to pass through suddenly, or 
where the labors are rapid, as in the case of women 
who have given birth to several children, much mis- 
chief may be done by tearing the soft parts. 

After the birth of the head there is a short interval 
of rest, when the shoulders are born; the rest of 
the body easily slips out; and with the expulsion 
of the after-birth the labor is over. 

At the very beginning of labor the patient should 
be given a full warm tub-bath, and. make an entire 
change of linen. She will usually prefer to be 
dressed in her night-clothing, over which during 

the first stage she may wear a loose wrapper; a 
*3 



*94 Maternity. 

sterilized napkin should be worn over the vulva dur- 
ing this stage. During the first stage, as a rule, 
the patient should not be confined to bed until the 
dilatation is well advanced; she is generally more 
comfortable if she is allowed to move around the 
room, and the pains are thereby advanced. 

The only way in which the physician can deter- 
mine whether labor has begun is by making an in- 
ternal examination ; and this will enable him to de- 
cide as to whether it is necessary to remain or not. 

The nurse should always wear a wash dress in 
the confinement and lying-in room. 

If the labor is long, nourishment in the form of 
beef-tea, broths, and milk may be given. No stimu- 
lants should be given without the direction of the 
physician. The frequent taking of cold water is 
permissible. 

At the beginning of the labor the family and 
friends must be excluded from the room, and it 
must be kept as quiet and as cheerful as possible. 

Toilet of the Patient. — The newly born child is 
received in a small blanket, is well wrapped, and 
laid in a warm place. The nurse then turns her 
attention to the mother; the external genitals and 
soiled parts of the body are cleansed with sterilized 
cheese-cloth wrung out of an antiseptic solution ; if 
the body-linen has become soiled, it is also changed, 
and all blood-stained articles are removed from the 



The Confinement. 195 

bed. The patient is then carefully lifted up on the 
permanent bed, and the vulvar pad and the ab- 
dominal bandage are applied; after which the pa- 
tient is allowed to rest. 



CHAPTER XIV. 

THE LYING-IN. 

Management of the Lying-in; Lactation; Nursing. 

" 'Tis is ourselves that we are thus or thus. Our bodies are our 
gardens; to the which, our wills are gardeners." — "Othello." 

Management of the Lying-in. — Immediately after 
the delivery the first essential for the patient is ab- 
solute quiet and rest; the room must be kept quiet 
and darkened, and ordinarily the patient is allowed 
to fall into a light sleep. During the first few hours 
after labor the best position for the mother is flat 
on the back, with only a small pillow under the 
head. After the first twenty-four hours the patient 
may be allowed to turn on the side as she prefers. 
Since absolute rest is the first requisite for the pa- 
tient, she must be left alone with the nurse, who 
must see that she does not fall into too deep a 
sleep. If the child's cries disturb the mother, it 
must be taken into another room. 

The lying-in room must be kept free from all 
odors, all soiled clothing must be at once removed 
from the room, and good ventilation must be in- 
sured, being careful to prevent any drafts. 

196 






The Lying-in. 197 

While the patient is asleep, and after the baby 
has been attended to, the nurse should place all 
blood-stained articles in cold water to soak. If in 
the city, the after-birth may be burned in the furnace 
or range; it should be well covered with coal. In 
the country the after-birth can be buried in a deep 
hole. 

During the first two or three days the vulvar 
dressings should be changed from every three to 
six hours, and at all times as often as they are soiled. 
Each time that the dressing is renewed the external 
genitals and their immediate surroundings are to 
be carefully cleansed with sterilized water, and fin- 
ally washed with a solution of boric acid, in the 
proportion of one tablespoon ful of boric acid to one 
quart of water. It is convenient to keep this solu- 
tion mixed and on hand, as it takes some little 
time to prepare it; it should be kept in a strength 
double that which is desired, so that it may be di- 
luted with warm water to give the desired tempera- 
ture. This solution may be poured over the parts 
from a small pitcher, the douche-pan having been 
placed under the patient before the washing began. 
After labor the vulva is very sensitive, so that while 
the greatest care must be used to remove all clots 
of blood and the discharge, there must be no brisk 
rubbing of the parts. No blood-stained linen should 
be permitted to remain about the patient or the bed. 



198 Maternity. 

Since the lying-in woman perspires freely, her 
skin ought to be frequently cleansed by sponging 
with a weak solution of alcohol in. tepid water; this 
should be followed by friction with a towel until 
the skin is in a glow. Cleanliness of the bed is 
promoted by the use of a draw-sheet, which is a 
sheet folded to four thicknesses and placed beneath 
the patient's hips in such a way that the upper edge 
of the sheet shall come under the lower part of the 
pillows. Air and light must be freely admitted at 
all times in order that the room may be bright and 
cheerful. For the first few weeks the eyes of the 
new-born infant should be shielded from all strong 
light. 

Visitors. — For the first week after the confine- 
ment the patient should see no visitors. Even the 
husband or mother should not remain in the room 
long at a time. Nothing of a disagreeable nature 
should be told to the patient; and whoever goes 
into the sick-room should always carry the most 
cheerful manner, as it is highly necessary that the 
patient should be kept mentally as well as physically 
quiet at this time. 

Diet. — For the first twenty-four hours the diet 
must be restricted to liquids, and in most cases 
nothing is given until the patient has had a few 
hours' rest. The first thing that is given to the 
patient should be a cup of warm milk or tea. Milk 



The Lying-in. 199 

is the best diet; this may be varied with beef-tea, 
bouillon, mutton or chicken broth; any of these 
broths may be made with rice or barley to vary 
the flavor, but these must not be given to the patient. 
The patient should have six ounces of the liquid 
every two hours during the day and every three 
hours during the night. 

On the second day bread well toasted through 
may be added to any of the liquids. On the third 
day stewed or baked apples should be added to the 
diet. On the fourth day, and from this on, the 
patient will have regular meals, but the diet must 
be a plain one. For breakfast, stale bread, a soft- 
boiled egg, fruit, and a cup of tea, not too strong. 
For dinner, which should always be given in the 
middle of the day, an oyster-stew or clam broth, a 
lamb chop, or a very small piece of beefsteak or 
chicken; but with these there must be no gravies 
or dressings; a potato baked in the skin; raw to- 
matoes, if in season; apple sauce or cranberry; 
celery; junket, plain corn-starch, lemon jelly, plain 
cup-custard. From this list the diet must be ar- 
ranged so as to give as much variety as possible 
from day to day. Midway between breakfast and 
dinner, and again in the middle of the afternoon, 
the patient should have a glass of milk. The diet 
should be generous, but simple. 

Urination. — The feeble condition of the bladder 



2oo Maternity. 

in the first few hours after delivery frequently leads 
to the retention of urine. Owing to the copious 
secretion of urine which is so common at this time, 
painful and injurious distention of the bladder may 
result. The patient should therefore endeavor to 
pass her urine in at least six hours after labor, 
whether she feels any inclination to do so or not; 
the sound of running water or warm fomentations 
over the bladder, warm water in the douche-pan, 
and moderate pressure applied by the hand over 
the suprapubic region, are often effective in accom- 
plishing the desired result. If all these means fail, 
the catheter must be used as the last resort. Dur- 
ing the entire lying-in the bladder should be emptied 
every six hours. 

Evacuation of the Bowels. — There should be an 
evacuation of the bowels in from twenty-four to 
thirty-six hours after the labor. For this purpose 
a mild laxative such as the extract of cascara sagrada, 
in i- or 2-grain doses at night, may be given. If this 
does not suffice, an enema of warm water, to which a 
little soap or two teaspoonfuls of glycerin have been 
added, may be given. Two pints of water should be 
prepared; the patient will retain as much as she 
comfortably can and as long as she can. The bowels 
should be opened daily after the first day. 

After-pains are caused by the same physiologic 
process that causes labor pains — namely, by the 



The Lying-in. 201 

contractions of the uterus. After the first confine- 
ment the after-pains are, as a rule, not severe; at- 
tention to the regular emptying of the bladder and 
bowels also lessens the severity of the after-pains; 
these pains seldom last after the second day. 

The Lochia. — The discharges of the mother con- 
tinue for about two weeks, and are called lochia. 
For the first twenty-four hours they are pure blood ; 
the second and the third day they are of the char- 
acter of bloody water; from the fourth to the sixth 
day they have a greenish-yellow color, and from 
the tenth to the twelfth day they become pure white. 
Soiled napkins and dressings should never be al- 
lowed to remain in the patient's room. 

Duration of the Lying-in. — This lasts for six 
weeks. During this time the organs of generation 
are returning to their normal size and condition. 
In order that the woman may be in the best con- 
dition possible at the end of this time, it is essential 
that for the first two weeks she should remain in 
bed; and so long as there is any blood in the dis- 
charge the woman should not be allowed to sit up. 
The first sitting up should be in bed, the patient 
being supported by a bed-rest. During the second 
two weeks the patient may be allowed to divide her 
time between the bed and the couch; in the latter 
part of this time she may be allowed to go around 
her room a very little ; and for two weeks more she 



202 Maternity. 

should remain on the same floor. The first sitting 
up should not last more than half an hour. Getting 
up and going around too soon after the confine- 
ment, " being too smart," is one of the most pro- 
lific sources of falling of the womb, and all manner 
of uterine trouble, by which the general health of 
the woman is greatly impaired. 

Lactation. — If it is at all possible, every mother 
should nurse her own child ; in the interests of both 
the mother and the child. The ability to nurse a 
child successfully is one of the greatest blessings 
alike to the mother and to the child. It brings 
mother and child together in every sense of the word 
as nothing else can or will, and develops a maternal 
love which those deprived of it do not realize. To 
the child it usually means peaceful days and nights 
and a steady gain. So far as the mother is con- 
cerned, the process of lactation is beneficial be- 
cause it hastens the return of the uterus to its normal 
size. Wet-nurses are known tyrants, and if the 
quality of the milk has anything to do with the 
disposition of the child, as is believed to be the 
case, the idea is distasteful of having a woman who 
belongs to the lower classes provide nourishment 
for your child; and artificial feeding is one unmiti- 
gated trouble. 

A deficiency of the quantity or the quality of the 
mother's milk can generally be remedied by the 



The Lying-in. 203 

diet and attention to the health of the mother; if 
the deficiency in quantity persists, the mother's milk 
can be supplemented by artificial feeding. 

There may exist certain conditions of the mother 
in which nursing her own infant would be inadvis- 
able or even impossible. Syphilis contracted late in 
the pregnancy, and tuberculosis, are contraindica- 
tions, owing to the danger of the mother infecting 
the child. Inversion of the nipples, their excoria- 
tion, or persistent sensitiveness may make it impos- 
sible. In marked general debility of the mother 
from any cause whatever, it would be injurious to 
the mother and the child. 

After the mother and the new-born infant have 
had some hours of rest and sleep, it is advisable to 
apply the child to the breast, to receive by this first 
effort the small quantity of milk which is an especial 
provision to act as a natural purge and to start the 
bowels of the child into a healthy activity ; this also 
excites the milk glands to secretion. The mother's 
milk in full supply may be expected in from forty 
to sixty hours after delivery. 

Nursing. — When the mother's nipples are of the 
normal size and well formed, the healthy infant 
instinctively suckles at once when placed at the 
breast, but sometimes it has to be taught ; by squeez- 
ing out a few drops of milk to wet the nipple, the 
child will usually take hold, or a little sugar and 



204 Maternity. 

water may be put on the nipple; a little patience 
and tact are all that is necessary to insure success. 
But the infant must be taught to nurse at once be- 
fore the breasts become engorged" with milk. 

Under ordinary circumstances the child is to be 
kept at the breast for one year. But if within this 
time the menstrual period should recur and be pro- 
fuse, or should the woman again become pregnant, 
the quality of the milk becomes poor, and necessi- 
tates the immediate weaning of the child ; the char- 
acter of the milk is also altered, and even its secre- 
tion may be checked. Nervous agitation may so 
alter the quality of the milk as to make it poisonous. 
A fretful temper, fits of anger, grief, and sudden 
terror not only lessen the quantity of the milk, but 
render it thin and unhealthful, inducing disturbances 
of the child's bowels, diarrhea, and so forth. 

Position of the Mother When Nursing. — When 
in bed in the recumbent position, the mother should 
lie on that side from which the infant is going to 
nurse ; when up, the mother should sit erect. 

Care of the Nipples. — Immediately after each 
nursing the nipples should be washed off in a satu- 
rated solution of boric acid in cold water, and dried 
with a soft cloth. During the interval between nurs- 
ings the nipples should be protected by a small 
square of sterile lint on which is spread some steril- 
ized petrolatum. This prevents the binder from 






The Lying-in. 205 

sticking to the nipple and removing some of the epi- 
thelium when it is loosened. If the skin of the 
nipple is very sensitive, a nipple-shield should be 
used for the first few days; or, should the nipple be- 
come sore at any time, the shield can be resorted to. 
The nipple-shield must fit tightly; the best ones are 
made of glass with a rubber tip. In the intervals of 
nursing the nipple-shield should be kept in cold 
water after it has been thoroughly cleansed by being 
brushed on both sides. 

The breasts are sometimes distended from an 
over-secretion of milk; this is relieved by saline 
cathartics, by abstinence from liquids, and by the 
use of a compression breast bandage. This is made 
of a straight piece of muslin, with a shallow notch 
cut in one edge for the neck, and a deep one for 
each arm; the bandage is closely applied over the 
breasts, and the ends pinned in front; it is also 
pinned over the shoulders. 

In debilitated women the supply of milk may 
be insufficient; the most reliable evidence of this 
is the fact that the infant ceases to gain in weight. 



CHAPTER XV. 

THE NEWBORN INFANT. 

Method of Ligation and Dressing of the Cord; 
The Infant's Toilet; The Meconium; The Baby's 
Bath; The Crib; Feeding of Infants; The Scales 
and the Thermometer; The Wet-nurse; Artificial 
Feeding; Characteristics of Healthy Infants; the 
Stools; Constipation; Urination; Dentition. 

'O thou child of many prayers, 
Life hath quicksands; life hath snares." 

—Longfellow. 

Method of Ligation and Dressing of the Cord. — 

The ligation and dressing of the cord is always done 
by the attending physician; but it sometimes happens 
in women who have very rapid labors or at the mis- 
sionary outposts that the baby is born before the 
doctor's arrival. In that case this must be performed 
by the nurse. One of the greatest dangers to which 
the newborn child is exposed is infection of the navel. 
In order to avoid this the greatest care should be ob- 
served in the treatment of the umbilical cord and its 
stump until the cord is off and the navel thoroughly 
healed. 
The drier the stump can be kept, the sooner the 

cord separates and the stump heals. In order to have 

206 



The Newborn Infant. 207 

this stump small and as dry as possible the blood and 
Wharton's jelly of this portion of the cord is gently 
stripped toward the placenta before the ligature is 
placed. The cord is then ligated at 1 inch from the 
abdomen; a second ligature is then applied between 
the first and the placenta at about 1 inch distant. 

The ligation and cutting of the cord must always 
be done with sterile hands. The tape, instruments, 
and the baby should not be touched by anything 
non-sterile until after the cord dressing has been 
applied. After the ligation of the cord it is at once 
covered with a small square of sterilized gauze held 
in place by a gauze bandage. For the permanent 
dressing, to be applied immediately after the bath, 
a square of sterilized gauze cut up to its center is 
taken, which allows the cord to pass through the slit; 
the stump of the cord is laid on the left and the ends 
of the gauze are folded over this; the whole is kept in 
place by a long, wide strip of gauze which serves as 
an abdominal binder until the cord drops off. This 
cord dressing, sterile in itself and applied with sterile 
hands, is not removed unless accidentally soiled until 
five days have elapsed. If the outer band becomes 
soiled, it can be replaced by a clean one. The average 
date of the separation of the cord is the eighth day. 

The Infant's Toilet. — So soon as the mother has 
been made comfortable, the toilet of the infant is 



208 Maternity. 

attended to; this must be done in a warm room. 
The baby is placed on the lap of the nurse in a warm 
sterile towel and is anointed from head to feet with 
some sterile oily substance like sterilized petrolatum 
or albolene, to remove the cheesy substance which 
covers the entire body. The head is first gone over, 
particular attention being given to the ears; then 
comes the neck, shoulders, arms, chest and back, 
groins, external genital organs, and the lower ex- 
tremities. After the baby has been thoroughly gone 
over with sterile hands, it is then wiped clean with 
a sterile towel. The baby is not bathed for six 
hours after birth and is not put in a tub until the 
cord is off. There should never be any odor about 
the cord. 

After the baby has been bathed on the lap of the 
nurse it may be dressed. A flannel band is used from 
the time the sterile dressing of the navel is dispensed 
with until the baby is one year old. This not only 
gives warmth to the baby's abdomen, but furnishes 
support to the umbilicus, tending to prevent hernia 
from crying of the baby, should there be any tendency 
to umbilical weakness. Care must be taken to apply 
the band firmly enough to give support to the ab- 
domen, but not tightly enough to crowd up the 
stomach and interfere with digestion. The bath is 
given on an empty stomach, and allowance should be 



The Newborn Infant. 209 

made for this; the binder should be loose enough to 
allow two fingers to slip under it. 

After the application of the binder and the napkin 
comes the undershirt; the ringers of the nurse are 
passed up through the sleeve to seize the infant's 
hand and pull it through; as soon as it gets a little 
older the child will grasp a ringer laid in its palm, 
which will greatly facilitate this part of the toilet. 
Infant's merino drawers come in two pieces to allow 
space for the napkin and avoid soiling. These are 
next put on and the socks are fastened to these; then 
comes the flannel petticoat, which is best made in 
the form of a slip to pass over the shoulders, and 
should be long enough to come well below the baby's 
feet in order that it may be folded back to keep the 
feet warm. A long muslin slip completes the toilet. 
All of the clothing should be changed night and 
morning. 

The eyes and mouth should be washed out with 
separate pieces of fine gauze. For the mouth, a small 
piece of gauze wet with warm water is wrapped 
around the little finger of the right hand, going into 
the left angle of the baby's mouth and coming out at 
the right, going between the gums and the cheeks as 
well as over the tongue. This proceeding should be 
gone through with every time preceding and follow- 
ing the nursing, and in this way the milk is kept from 



210 Maternity. 

souring in the mouth, and the digestion is kept in good 
condition. A sore mouth in a baby indicates care- 
lessness on the part of the nurse. 

A soft hair-brush may be used, but the scalp is too 
tender to permit the use of a comb. 

After the toilet has been completed the baby is 
laid in its crib, on the right side of the body, and care- 
fully covered. The weaker the baby, the more atten- 
tion must be paid to the external warmth. It may be 
necessary to place a warm water-bottle in the crib, 
but this must not touch the infant. 

The Meconium. — The first discharge that comes 
from the bowels is of a dark greenish color, and 
should come away during the first twenty-four hours; 
if it does not, the baby may suffer a good deal of 
pain, and an enema of one tablespoonful of warm 
water must be given. As this substance is very 
difficult to be washed out of napkins, the first ones 
should be old and afterward burned. 

Cleansing. — Every time the napkin needs to be 
changed, even if it is only wet, the baby should be 
washed with warm water. A napkin should never 
be used twice without washing; it chafes the child, 
and it is an unsafe as well as a filthy practice; the 
napkin must always be removed as soon as it is wet. 

The Baby's Bath. — For this purpose are needed a 
bath-tub which can be easily cleansed, some pure 



The Newborn Infant. 211 

Castile soap, a thermometer, and a very soft wash- 
cloth which can be easily laundered and sterilized. 
The baby's bath-tub is rilled about one-third full of 
water at a temperature of ioo° F., tested by the 
thermometer and the nurse's hand. The first step 
in the bath should be the washing of the face and 
scalp, and this should be done on the lap of the 
nurse before the baby is put in the tub. The baby is 
then ready to have its clothing removed and be 
gently lifted into the tub, putting the feet in first 
and gradually immersing the body, with the excep- 
tion of the head, which is supported on the left wrist 
of the nurse, which passes under the infant's neck, 
while her hand grasps the left shoulder; with the right 
hand the nurse quickly rubs over the child's body; the 
entire bath should not occupy over five minutes. 
After carefully washing all parts of the body, espe- 
cially in the creases of the groins, genitals, and arm- 
pits, great care must be taken to see that these parts 
are thoroughly dried; otherwise excoriation of these 
parts will occur. The baby is then lifted into the 
lap of the nurse, on which is spread a soft, warm 
towel, which is at once folded about it in order to 
avoid chilling. By gently patting the towel about 
the baby the skin is dried. The creases are then 
dusted with talcum powder and the baby is ready to 
be dressed. 



212 Maternity. 

The Crib, — The infant must have its own crib, 
without rockers, and it must on no account be put 
to sleep in the same bed with its mother. In its 
early life it should never be taken out of its crib 
except to be fed, to have its clothing changed, or 
to be bathed. There should be no holding on the 
lap, no dangling, no carrying or fussing over the 
new-born infant; and the more the baby is let 
alone, the better and healthier it will be. If baby 
cries, look at once to see if it needs a fresh napkin ; 
if not, if any pins are sticking into it, if the cloth- 
ing is possibly too tight: if none of these things 
are wrong, give it a sup of water and turn it over 
on the other side. The baby often becomes restless 
by sleeping for several hours in the same position. 
But on no account take the infant up out of its 
crib simply because it cries. 

Cheerfulness and good nature on the part of the 
infant are dependent on its general good health. 
A healthy infant should not have colic, but if such 
is the case, there is a peculiar look of distress on the 
face, which indicates that the child is in pain ; what 
is needed is warmth or medication according to the 
severity of the case, but never floor walking. Begin 
the latter procedure, and you may hope to keep it 
up for several years. 

Ventilation. — The air is sometimes vitiated for 
children's uses in various ways; their nervous sus- 



The Newborn Infant. 213 

ceptibilities are greater than those of older people. 
A very little odor of tobacco may cause nausea and 
discomfort to an infant in arms. The atmosphere 
of the room should be sweet and pure and unseen ted. 
All scents and perfumes affect the nervous system, 
and by constant excitation do it damage. A bou- 
quet of flowers renders the air of a closed room too 
heavy. 

Feeding of Infants. — For the first nursing the in- 
fant may be put to the breast in from two to six 
hours after the labor if the mother is sufficiently 
rested; five minutes is long enough for each nursing. 
Before each nursing the nipples should be carefully 
washed off with a solution of boric acid. The first 
secretion of the breasts is laxative; that is, it acts on 
the bowels, and makes it unnecessary to give the 
infant anything to take for this purpose. The 
breasts should be used alternately in feeding the 
infant, as this allows a longer time for the accumu- 
lation of the milk. For the first few days the in- 
fant needs very little food, and the mother's milk is 
generally sufficient. 

Until the secretion of milk is established in the 
breasts, which is usually on the third day, the baby 
should be put to the breasts only infrequently. It 
should first be put to the breast as soon as the mother 
has had a rest, and then every four hours during the 



214 Maternity. 

daytime, but not at night until the secretion of milk 
is established. 

During this period the baby should not remain at 
the breast longer than five minutes at a time, for if 
allowed to remain longer the nipple is very apt to 
be made tender and perhaps become abraded. That 
it should be put to the breasts during this period is 
important for several reasons. It stimulates the 
contractions of the uterus, which is important at this 
time. The colostrum serves as a laxative for the 
baby and aids in emptying its intestines of meconium 
in preparation for the milk which is soon to be secreted; 
and the nursing of the baby upon the breasts tends 
to stimulate their function and hastens the milk 
secretion. 

During this period the amount of fluid needed by 
the baby is supplied in the shape of a 5 per cent, 
sugar solution or plain boiled water given at regular 
intervals, usually between the nursings. With the 
establishment of the milk secretion regular habits 
of nursing should be instituted. During the first 
week of the baby's life it usually needs seven feedings 
in the twenty-four hours. That means that the baby 
should be put to the breast every three hours during 
the daytime. The mother should be disturbed as 
little as possible during her sleeping hours, but for the 
first week it may be necessary in the interests of the 



The Newborn Infant. 215 

baby and the comfort of the mother's breasts to have 
the baby nurse twice between 10 p. M. and 7 A. m. 

Duration of the Nursing. — As a rule, a normal 
baby at a normal breast during the first month will 
obtain sufficient nourishment in from eight to twelve 
minutes. If the milk flows very freely the time may 
have to be reduced to six minutes and the baby may 
not care to nurse longer. If, on the other hand, the 
milk flows very slowly and the baby is large and 
strong, twenty minutes may not be too long. This 
should be considered the limit for a single nursing, 
and is usually not reached until the baby is several 
months old. 

The infant should be given a teaspoonful of cool 
water to drink two or three times a day, as the 
milk does not quench the thirst. The water should 
be sterilized by boiling, and be kept in an air-tight 
flask. 

The Scales and the Thermometer. — The best evi- 
dence of the proper nutrition of the child is a pro- 
gressive gain in weight. The use of the scales in the 
present-day nursery is considered just as much of the 
daily routine as giving the baby its bath. It not only 
tells by the steady increase of the weight of the baby 
that the mother's milk is sufficient in quantity, but 
also that it is of the proper quality. Furthermore, by 
accurately weighing the baby just before and after 



216 Maternity. 

nursing the exact amount of nourishment obtained 
from the breast can be told. 

The nursery scales must have a firm standard; it 
should have a capacious scoop and it should register 
half ounces, preferably with an arm, along which 
the weight is passed. 

The average weight of a .baby at birth is 7 pounds. 
During the first three days the baby loses, on an aver- 
age, about 10 ounces. With the inflow of the mother's 
milk the baby begins to gain under proper conditions 
from I to 1 ounce per day. It is expected that a baby 
on its mother's milk will have regained its birth 
weight in ten days. A bottle-fed baby not infre- 
quently requires a month to get its birth weight 
back. 

The thermometer, like the scales, has come to be 
regarded as an important instrument in the proper 
care of the baby and its routine daily employment a 
necessity. It is one of the best instruments for deter- 
mining that the baby in the first few days of its ex- 
istence is obtaining sufficient nourishment. The most 
frequent cause of a baby's high temperature at this 
time is insufficient nourishment, especially fluid, and 
this temperature is often spoken of as "starvation 
temperature." 

The rectal temperature of the baby should be taken 
night and morning for the first ten to fourteen days, 



The Newborn Infant. 217 

and once a day after that for the remainder of the 
month. A rise of temperature in the first few days 
should always suggest, other conditions being normal, 
a lack of fluid nourishment. If the mother's milk 
secretion is delayed, the baby should either be given 
sugar solution every three hours or put upon a weak 
formula of modified milk. 

The Wet-nurse. — When the mother for any rea- 
son whatever is not able to nurse her child, the best 
substitute is a wet-nurse. Before she is employed 
the wet-nurse should always be carefully examined 
by a physician to insure her freedom from disease. 
The best age is between twenty and thirty years, 
and the age of the child of the nurse should be at 
least within a month of that of the child to be 
nursed. The best sign of the good health of the 
nurse and of the condition of her milk is furnished 
by the health of her own child. The breasts should 
be well formed and the nipple of good shape. It is 
well, if possible, to get a woman who has borne 
several children, as she will understand the care of 
the child better. No woman who is not perfectly 
healthy is fit to be a wet-nurse; and even after she 
has been engaged her health and her habits must be 
watched over. 

Artificial Feeding. — There is one principle which 
always guides the artificial feeding of infants: the 



218 Maternity. 

baby should always be started on a food so weak that 
almost any baby could digest it, and then the strength 
and quantity of the milk should be gradually in- 
creased as the baby shows its ability to digest, more 
care being taken not to increase so rapidly in either 
strength or amount as to upset the digestion or 
cause dilatation of the stomach. A baby whose food 
is increased too rapidly is usually so upset as to re- 
quire a considerable period of patient effort to get it 
back to its normal condition. 

If the baby seems well, sleeps well, has normal 
stools, and gains a little each week it is usually wise 
to be satisfied rather than to attempt to surpass the 
neighbor's baby in weight. 

The first requisite in artificial feeding is that the 
milk shall be made to correspond as nearly as possible 
to that of the mother. For this purpose the follow- 
ing formula, prepared by Rotch, of modified cows' 
milk is considered the best: 

Milk 2 ounces 

Cream 3 ounces 

Water 10 drams 

Milk-sugar 6$4 drams 

Lime-water i ounce 

To make one pint of the mixture for use in the twenty- 
four hours, take the milk and cream as soon as it 
comes in the morning, and mix as above directed. 



The Newborn Infant. 219 

No less important than the correct proportions 
of the ingredients, is freedom from disease germs 
and bacteria of putrefaction. Complete steriliza- 
tion is possible by prolonged boiling ; but experience 
has proved that under prolonged exposure to a 
temperature near the boiling-point certain changes 
take place in the albuminoids of the milk which 
greatly impair its digestibility. Full sterilization 
of milk for infant feeding has therefore practically 
been abandoned. It has been found that milk 
heated to 167 F. for twenty minutes, and promptly 
chilled by placing on ice, remains practically sterile 
for twenty-four hours, and it is spared the injurious 
changes which take place at a higher temperature. 
This process is known as Pasteurization. The Ar- 
nold steam sterilizer affords a convenient method of 
sterilizing; if used with the cover removed, the 
steam chamber being open, the temperature of the 
steam chamber does not exceed 170 F. 

It is claimed that in the Arnold steam sterilizer, 
with the use of a suitable gas stove, the water begins 
to boil at the end of two minutes after the gas is 
lighted. A four-ounce bottle of milk at an initial 
temperature of 70 F. in the open steam chamber 
attains a temperature of 170 in just one hour. An 
exposure of about one hour and twenty minutes 
in the steam chamber is therefore necessary for the 
Pasteurization. 



220 Maternity. 

The rules for sterilizing are as follows : 

First, clean the bottles thoroughly; then place 
them in cold water, which is allowed to come to boil 
and boiled for ten minutes. 

Second, fill each with the milk you wish to use; 
put in the rubber cork without the glass plug ; this 
leaves a small opening in the rubber cork; set the 
bottle in the basket, then in the boiler. 

Third, set in the refrigerator until needed for use. 

Fourth, when wanted for use, place a bottle of 
the milk so prepared in the tin mug which accom- 
panies the sterilizer; fill the mug with hot water 
to the height of the milk in the bottle, heat the milk 
to the temperature of 99 ° F., remove the rubber 
cork and put on the nipple, when it is ready for use. 

Fifth, cleanse the bottle immediately after using; 
throw away any milk that has not been used. 

Sixth, if the steaming process is preferred, place 
the basket without the bottles in the boiler, fill the 
water up to, but not above, the bottom of the basket, 
place the bottles in the basket, and proceed as 
before. 

It is important that the milk should be sterilized 
or Pasteurized as soon as it is served in the morning. 
Each bottle must be thoroughly washed as soon as 
it is emptied. Milk sterilized in this way will keep 
for days without spoiling, as it is hermetically sealed 
and all the unhealthy germs have been removed. 



The Newborn Infant. 221 

The most exact method for the artificial feeding 
of infants, and that which most nearly approaches 
the mother's milk, is that used by the "Walker- 
Gordon Laboratory," branches of which are to be 
found in many of the large cities. 

Not only is the greatest care taken that the milk 
used shall be pure and sterilized ready for use, but 
these laboratories are equipped by special machinery 
which separates the important elements of the milk 
— namely, the fat, the milk-sugar, and the proteids. 
So that the physician can modify the proportions of 
these various ingredients of the milk to meet the 
necessity of the age and requirements of the infant. 

When the milk contains too little sugar, the infant 
does not gain as rapidly in weight as it would other- 
wise do Too much sugar in the milk is indicated 
by colic, thin, green, or acid stools, or eructations 
of gas from the stomach. 

An excess of fat in the milk is indicated by vom- 
iting; too little fat causes constipation with dry 
hard stools. Proteids in excess are a prolific cause 
of colic and also of diarrhea. 

Prescription blanks are furnished the physician, 
who fills out the percentages of fat, milk-sugar, 
proteids, and alkalinity, to suit the age, weight, and 
general condition of the child. He orders also the 
amount to be given at each feeding, and the number 



222 Maternity. 

of feedings to be given in the twenty-four hours. 
Each bottle contains just the amount to be given 
at one feeding. All that the mother needs to do 
is to place the bottle in a receptacle containing warm 
water, until the milk has attained a temperature 
of 99 F., remove the cotton stopper, and put on 
the nipple, when it is ready for use. 

The Nursing Bottle. — This should be of clear 
glass, with a rounded bottom, and of such a shape 
as is easy to clean; so that no particles will cling 
around a corner which cannot be reached. The 
graduated bottle is the most convenient, as it enables 
the quantities of each of the materials used in the 
preparation of the feeding to be mixed in the bottle, 
doing away with the trouble of measuring before 
putting into the bottle. 

Rubber Nipples. — Two nipples should be kept for 
alternate use, and no nipple should be used longer 
than two weeks. A soft rubber of conical shape is 
best, with an opening at the top which is not too 
large, so that the milk will not flow through, as 
it is desirable that the child should obtain the milk 
by suction. So soon as the feeding is over, the 
nipple should be removed from the bottle, and 
brushed on both sides with a stiff brush. It should 
then be put in cold water, where it is kept until it 
is again wanted. 



The Newborn Infant. 223 

The baby should be fed slowly, from ten to twenty 
minutes being taken for each feeding. Sucking 
from an empty bottle or with a. nipple in the mouth 
should never be permitted, as in this way the baby 
draws air into its stomach, which will result in 
colic. Each flask should contain only enough for 
one feeding. 

In lieu of the regular sterilizing apparatus, milk 
may be similarly prepared by placing the milk in 
an ordinary glass fruit- jar with a screw lid. This 
is placed in a colander over a pot of boiling water ; 
the milk should be allowed to boil in the open jar 
for two minutes; the jar-lid is then screwed on, 
and it should steam for twenty minutes longer. 

The capacity of the infant stomach at birth is 
about one ounce, which is the average quantity of 
food that should be taken at one meal. The aver- 
age rate of increase in the amount of food is one 
and a half drams a week for the first six months; 
subsequently somewhat less. The intervals of feed- 
ing should be two hours at birth, and increased to 
three hours at the end of the third month. The 
food should be given at a temperature of 99 ° F. 
and fed directly from the sterilizing bottle. 

Fresh Air. — In warm weather the baby is taken 
out-of-doors in from three to four weeks after birth ; 
in cold weather not before two to three months. 



224 Maternity. " 

In the latter case it is prepared for the change by 
being first dressed as for the street, with wrap and 
cap ; the windows of the room are then opened, and 
the infant is carried about here. In the winter 
months when the baby is first taken out, it is better 
to carry it in the arms, as it will be kept warmer 
in this way, and if it does become chilled it will be 
more quickly noticed. 

Characteristics of the Healthy Infant. — The 
average weight of an infant at birth is about seven 
pounds, and its length is about twenty inches; the 
extremes are four pounds or a little less up to eleven 
pounds. The head and trunk of the child are de- 
veloped out of proportion to the limbs. 

The skin of the new-born infant varies from 
pinkish to red; about the fourth day the color 
becomes somewhat yellowish ; this tinge should dis- 
appear about the end of the second week, and at 
the same time the skin begins to peel off. This 
process lasts about two weeks longer, when the 
baby's skin takes on its normal color. 

The shape of the head varies greatly, much being 
due to the amount of pressure during labor; but 
this disappears in a few days. As a rule, the large 
bones of the head are felt to be separated by mem- 
branous ridges called sutures; there is one on the 
median line on the top of the head, and at either 



The Newborn Infant. 225 

end of the suture is a large open space, called a 
fontanel. The largest one is at the front of the 
head, and is called the anterior fontanel ; it is about 
large enough to be covered by the tips of two fin- 
gers, and is of a lozenge shape; this opening does 
not close till the child is about eighteen months 
old. In a healthy baby this fontanel should be on 
a level with the bones of the head; a slight pulsa- 
tion may be noticed in it, due to the pulsations of 
the vessels of the brain. There is a much smaller 
three-cornered fontanel at the back of the suture, 
and one behind either ear ; these soon close up with 
bone. 

A new-born baby cannot probably do any more 
than distinguish" light from darkness. Up to the 
sixth week there is an inability at coordination of 
the ocular muscles; after this time the eyes begin 
to move in an orderly manner, and they will follow 
a bright object moved slowly in front of them. 
At about the end of the second month rapid move- 
ments are perceived, as is evinced by the child's 
closing its eyes quickly on an object suddenly ap- 
proaching it. At three months the child begins 
to recognize colors ; the first recognized are yellow, 
red, pure white, gray, and black. But the faculty 
of distinguishing between colors is not perfected 
till the third year. The mother is recognized about 
15 



226 Maternity. - 

the third month. Hearing and a sense of smell 
develop rapidly after birth ; loud noises in its vicin- 
ity will cause a child to start during the first day 
after birth. By the time the child has reached 
three months of age it shows signs of having a mind 
of its own, and is capable of exercising thought. 
It grasps for objects, and indicates its likes and 
dislikes. At from eight to ten months it can utter 
several syllables, and at the age of one year should 
be able to say mama and papa; at two years it 
should be able to frame short sentences. 

Weight of the Baby. — By the end of the sixth 
month the child's weight should be double what it 
was at birth; that is, about fourteen pounds; at 
the end of the twelfth month be three times as much 
as at birth, or about twenty pounds. 

Muscular Action. — Muscular action in the new- 
born infant is entirely involuntary, there being no 
voluntary acts until about the end of the third 
month. Sucking and licking are largely instinctive. 
The movements of the arms and legs are impulsive 
acts, and occur during sleep, just as they did in the 
intra-uterine life. The act of raising the head, 
which is attempted about the fourth month in 
healthy children, is volitional, requiring not so 
much added strength of muscle as power of co- 
ordination. As volition develops the power of co- 






The Newborn Infant. 227 

ordination gradually increases, and the child learns 
to perform voluntary or purposeful acts. Volun- 
tary grasping is done after the fourth month. As 
the child learns to balance its head, it attempts 
to sit up. This act is not successfully accomplished 
until about the fortieth week; the child sits firmly 
alone when ten or eleven months old. Before this 
time it is necessary to support the head and spine 
of the child with the hand. By the third or fourth 
month the infant should be able to grasp things. 
The child begins to creep about the ninth month. 
The clothing should be so arranged as to allow en- 
tire freedom of motion. 

It should be able to stand up by a chair by the 
tenth month, and be able to walk alone at the end of 
the first year. It is important that parents should 
know this, since not knowing what a normal baby 
ought to be able to do, cases of birth palsy, or even 
an attack of paralysis due to teething, are not infre- 
quently overlooked, not only by the mother, but 
even by the doctor, who attributes the inability of 
the child to do what other children can do at this 
age simply to weakness, which the child will out- 
grow ; and thus the time passes in which the most 
coukl be done to cure the child and to prevent the 
subsequent deformity. 

A baby should not be forced to stand or walk; 



228 Maternity. 

a very stout baby, on account of its weight, will 
stand up and walk much later than a slight one, the 
two being equally healthy. Or if a baby has been 
sick, it will feel no inclination to stand up. Natur- 
ally, a child creeps before it walks, and this develops 
the muscles of the lower limbs, so that they will 
support the weight of the child in standing. By 
prematurely forcing a child to stand up and walk, 
there is danger of causing bow-legs, as the bones 
of the legs are still weak; the child should be dis- 
couraged from standing up too much rather than 
encouraged to stand up more. 

Sleep. — A large proportion of the time of early 
infancy is spent in sleep; for the first few weeks 
the infant only wakens up to be fed. During sleep 
the eyelids should be tightly closed ; a partial open- 
ing of the lids, showing the whites of the eyes, 
is an indication of ill health. Up to the age of six, 
children require twelve hours of sleep at night, 
besides an hour or more in the middle of the day; 
the child should be permitted to sleep as long in 
the morning as it will. 

Respiration. — The healthy infant breathes on an 
average forty-four times a minute; the only time 
the respirations can be satisfactorily counted is dur- 
ing sleep. When the child is awake, the respira- 
tions are hurried by slight movements of the body, 



The Newborn Infant. 229 

crying, and so forth. The average pulse of a new- 
born baby is one hundred and forty; this is hur- 
ried by the same causes that hastens respirations; 
the pulse is most easily counted at the anterior fon- 
tanel. The average temperature of the infant is 
99 F. When the tip of the nose and the extremi- 
ties are cold, it indicates a lowered vitality. 

The nature of the child's cry indicates, variously, 
hunger, temper, or pain ; the mother will soon learn 
to distinguish these varieties. If the child cries 
because it is hungry, the cry ceases so soon as it is 
fed. But a child is never to be fed simply because 
it cries; it must be fed on the hour by the clock. 
If this rule is not strictly adhered to, it will suffer 
all the forms of indigestion and colic that babies 
are heir to. If it cries because of colic, there is 
a drawn look on the face, and at the same time the 
legs are sharply flexed on the thighs and the thighs 
on the abdomen. If the cries are due to earache, 
the head will be rolled about from one side to 
the other. In either case nothing will stop the cries 
until the pain is relieved. A baby does not shed 
tears until the third month. 

The Stools. — The stools of a very young baby fed 
on breast-milk should be of a yellow or orange 
color. There should be three or four evacuations 
daily; they should contain no curds. Stools of 



230 Maternity. 

bottle-fed babies are lighter in color and more offen- 
sive. 

Constipation. — Constipation is not uncommon in 
infancy; it may be overcome by the use of a soap 
suppository, or by an injection of warm soap-suds 
into the bowel, or by an injection of oil and water, 
or by gentle friction over the bowel, following the 
course of the large intestine. 

To make the soap suppository, take a piece of 
castile soap about an inch long, give it the shape 
of a cone not any larger than the end of the little 
finger, and make it perfectly smooth. This is in- 
serted to. about half of its length into the rectum 
and held there until it causes the bowels to move. 

The bowel injection is best given by means of 
the single-bulb syringe, known as the eye and ear 
syringe; the bulb holds about two tablespoonfuls 
of liquid. This may be warm cotton-seed oil, sweet 
oil, or glycerin one teaspoonful to warm water two 
tablespoonfuls. The nozle should be small, smooth, 
and well oiled. It should be very carefully intro- 
duced into the bowel, being directed a little to the 
left side, and the bulb gently squeezed to force the 
contents into the bowel. The injection is more effec- 
tive if it is retained for a little while ; this is accom- 
plished by making slight pressure on the anus with 
a towel. 



The Newborn Infant. 231 

Rubbing the abdomen for about ten minutes in 
the direction of the large bowel is sometimes very 
effective in overcoming constipation; begin in the 
right groin and rub up as far as the border of the 
ribs, then across to the left, then down on the left 
side. 

Vomiting. — Vomiting means often only that the 
stomach has been overfilled, and may be relieved by 
withholding all food for a few hours. 

Urination. — The frequency of urination in a new- 
born baby will vary greatly with the weather and 
other conditions; in cool weather it is not unusual 
for the napkin to need changing almost every hour. 
Healthy urine should not stain the napkin. The 
new-born infant secretes very little urine until it 
begins to take nourishment freely. The bladder is 
usually emptied during birth, and very often the 
bowels also, so that if the child seems well and there 
is no malformation of the parts, the family may be 
assured that the apparent retention of urine is only 
temporary. 

The use of hot fomentations over the kidneys and 
bladder will often hasten the evacuation of urine 
if it has been unduly delayed. If the secretion 
seems highly concentrated, a drop of sweet spirits 
of niter in a teaspoonful of water may be given 
every two hours. 



232 Maternity. 

Teething. — The first tooth generally appears about 
the end of the fourth month; in delicate children 
they come later. As a rule, the lower front teeth 
come first, coming in pairs, one tooth coming on 
each side of the mouth ; followed in about a month 
by the corresponding teeth in the upper jaw. Pre- 
ceding their appearance the gums become swollen, 
hot, and painful, and the saliva forms in excess and 
runs from the mouth. The child is irritable, flushed 
and restless ; and there usually occurs some disturb- 
ance of the bowels, commonly diarrhea. This all 
indicates a nervous derangement, and calls for a 
judicious diet and general careful oversight. The 
symptoms subside when the teeth are through. Dur- 
ing teething the child manifests a desire to bite 
on something, and a soft rubber ring will give it 
great comfort. 

The first set of teeth are twenty in number, and 
are usually cut in groups, starting about the fourth 
mouth and continuing until between the twentieth 
and thirtieth month, when the first dentition should 
be complete. As a rule there is an interval of rest 
between the eruption of the various groups. Dur- 
ing dentition children are generally more peevish 
and fretful than usual, but there should be no gen- 
eral constitutional disturbance. During dentition it 
is of especial importance to keep the bowels well 



The Newborn Infant. 233 

opened; it is better to have them too loose than 
costive; constipation at this time greatly increases 
the tendency to convulsions. 

Bottle-fed babies are apt to cut their teeth later 
than those nursed at the breast. The lack of ap- 
pearance of any teeth before the end of the first year 
indicates that the nutrition of the child is below par, 
or, in other words, that the child has rickets. The 
permanent teeth begin to appear about the sixth or 
seventh year. 



PART V.-THE MENOPAUSE. 



CHAPTER XVI. 

THE MENOPAUSE. 

Average Duration of the Menstrual Function; 
Duration of Menopause; the Menopause; General 
Phenomena of the Menopause ; Prominent Symp- 
toms of Menopause; Pathologic Conditions of the 
Menopause; Hemorrhage at the Menopause a 
Significant Symptom of Cancer ; Causes of Suf- 
fering at Menopause. 

*' Yet I doubt not through the ages one increasing purpose runs, 
And the thoughts of men are widened with the process of the suns. 

Knowledge comes, but wisdom lingers, and I linger on the shore, 
And the individual withers, and the world is more and more. 

Knowledge comes, but wisdom lingers, and he bears a laden breast, 
Full of sad experience, moving toward the stillness of his rest." 

— "Locksley Hall." 

Average Duration of Menstrual Function. — The 

average duration of the menstrual function is from 
thirty to thirty-two years. Raciborski estimated 
the duration of menstrual life at about thirty-one 

234 



The Menopause. 235 

years and nine months. According to him, the 
mean age of puberty at Paris was fourteen years 
and seven months; therefore, the average age of 
the menopause was forty-six and one-half years. 
Tilt gives the average age of the cessation of men- 
struation in 1082 cases as forty-five years and nine 
months. The average age is between forty-five and 
fifty years. It has been shown by Krieger, Kisch, 
and others, that the earlier the menses appear, the 
later they cease, and vice versa. However, when 
the first period is unusually early or late, the meno- 
pause comes very early. Also that the sexual func- 
tion is usually abolished earlier in the laboring 
classes, who are compelled to work hard and who 
have many cares, than in the well-to-do and rich. 

Race does unquestionably influence the duration, 
but given a sound healthy race, which is not too 
much enervated with civilization, and the menstrual 
process will, equally with the total physical vigor 
and the vitality, be increased. At the present day 
there is an increased sexual vitality, which shows 
itself in the fact that the duration of menstrual life 
has been increased three to four years during the 
past generation. The inference can be fairly de- 
duced that vigorous vitality causes prolongation of 
the menstrual process and the actual age. 

Duration of Menopause. — By the menopause or 
climacteric is understood the whole period from the 



2 3 6 The Menopause. 

beginning irregularities in the time of appearance 
of the menstrual flow until its actual cessation. The 
average duration of the menopause is from two 
and a half to three years. 

The Menopause. — The menopause is a physiologic 
and conservative process. It occurs at a time of life 
when all the tissues are most stable and the nutri- 
tion of the body is at its best. Other physiologic 
changes which occur at the same time are decrease 
in the size of the spleen and lymphatic glands, the 
muscular coats of the intestine atrophy, and lessened 
peristalsis ensues; hence the increased tendency to 
constipation. These are not the degenerations of 
age, but the blood-supplying, blood-making, and 
blood-elaborating organs of the body have com- 
pleted the growth of the organism, done their work, 
and are striking a balance with the needs of the 
economy. 

The object of each metamorphic or developmental 
epoch is a critical readjustment of the organism, in 
order to insure the greatest possible amount of 
health for each subsequent period of life. In the 
vast majority of cases this object is quietly effected, 
but sometimes the constitution only rallies after 
having been severely shaken for a varying period. 

General Phenomena of the Menopause. — Borner 
states that while many women pass this period with- 
out noting any change in their former condition, 



The Menopause. 237 

and are conscious of the occurrence of the change 
of life only by reason of the absence of the men- 
strual flow, others suffer for years with a host of 
troubles. 

One of the most essential changes is that of the 
woman's psychic condition — from slight vagaries, 
loss of interest in the daily affairs of life, to melan- 
cholia and insanity. 

" Two factors are generally taken into account : 
first, the sudden cessation of the menses; second, 
the reflections of the patient caused by her condi- 
tion, meditations on the loss of youth and sexual 
power, and anxiety in view of the dangers of the 
climacteric. It cannot be denied that there is some 
truth in the supposed sad thoughts about the begin- 
ning of old age, and the depression caused by them 
can scarcely be considered abnormal " (Borner). 

Napier believes that it is extremely rare for the 
cessation to occur without some physical discomfort 
or some disturbance of the nervous system, but adds 
that : " Some women, however, cease menstruating 
with very slight inconvenience." As a rule, the 
woman misses one, two, or more periods, then a 
menstruation of almost normal quantity and dura- 
tion ; and this is again repeated at gradually longer 
intervals, and with a diminished flow, until actual 
cessation occurs. 

The periods cease owing to the degeneration and 



238 The Menopause." 

disappearance of the glandular tissues of the uterus, 
and secondarily to similar changes in the ovaries 
and other glands. This is followed by an atrophy 
of all the structures of the genitalia. 

An increase in the size of the uterus, from increase 
in the amount of blood, is frequently noticed at the 
beginning of the menopause; later it becomes 
smaller in all its dimensions. The wall becomes 
thinner; the cervix becomes shorter and thinner, 
sometimes hard, sometimes flabby as a membrane. 
But the distinguishing feature of the menopastic 
uterus is atrophy of its lining membrane. 

The changes in the uterus and Fallopian tubes 
are earlier than those in the ovaries, so that ovula- 
tion, though lessened in activity, may persist for a 
considerable time after menstruation has ceased. 
Ovarian atrophy has been referred to senile rather 
than menopastic changes. 

Atrophy of the ovaries occurs very gradually. 
Peuch found that in one case the ovaries were of 
normal size three years after the establishment of 
the menopause. Kiwisch describes the structural 
change in this gland as consisting, on the one hand, 
of an increase of the connective-tissue stroma; and, 
on the other hand, the Graafian vesicles themselves 
undergo retrograde change. In consequence of 
these microscopic changes, which take place very 
slowly, the entire organ becomes harder and smaller. 



The Menopause. 239 

Napier believes that the ovaries secrete specialized 
substances which aid in determining menstruation; 
and that in a less degree the utricular glands and 
the glands of the Fallopian tubes share in this 
action. He considers that this is probably second- 
ary to the chain of peripheral irritation from the 
uterine glands, but that this secretion is none the 
less an essential feature of the menstrual process. 

In support of this view he calls attention to the 
pigmentation of the skin which occurs during preg- 
nancy and chlorosis, showing that the absence of 
the catamenia results in the retention in the blood 
of some substance which would normally be excreted 
at this time. 

Other atrophic changes in the genitalia are shriv- 
eling of the vulva, with prolapse of the vagina or 
uterus from relaxation of the ligaments and loss 
of the natural support afforded by the changed 
perineal body. 

Uterine catarrh occurs almost invariably, and 
only ceases in advanced years. Displacements of 
all kinds are frequent, but on account of the now 
greatly diminished weight of the uterus, these are 
insignificant. 

The vagina is at first almost always hyperemic, 
but this disappears as the vessels successively atro- 
phy. The vagina gradually becomes narrower and 



240 The Menopause. 

shorter. The mucous membrane loses its rugae and 
presents a pale, grayish, blanched hue. 

The researches of Byron Robinson, made by the 
dissection of a number of old women, show that 
after the menopause not only is there an atrophy 
of the genital organs, but that the hypogastric 
plexus of the great sympathetic nervous system also 
shrinks away. " It becomes smaller and firmer, 
and no doubt some strands disappear. On this fact 
must be based the pathologic symptoms accompany- 
ing the cessation of the menstrual function." 

The importance of the genital organs is shown 
by the vast nerve-supply sent to them. When this 
great nerve-tract becomes atrophic, so that it can 
no longer transmit the higher physiologic orders, 
all parts of the sympathetic system must be unbal- 
anced, until a new line, the next line of least re- 
sistance is established. And Robinson believes that 
this is the explanation of the many pathologic mani- 
festations of every viscus at the menopause; that 
is, " the irritation which arises by trying to pass 
more nervous impulses over plexuses than normal 
gives origin to what is unfortunately known as 
functional disease. It is just as organic as any 
disease, only we are unable to detect it." 

Chemical changes in the blood and tissues are con- 
stant vital phenomena; increased oxidation causes 
increased activity of the circulation, increase of tern- 



The Menopause. 241 

perature, increase of urea and carbonic acid in the 
economy from retrograde changes, and, finally, dur- 
ing menstrual life the flow of blood from the uterus 
carried off the effete materials from the highly 
charged system. 

The elimination of albuminoids, as shown by the 
altered condition of the blood after menstruation, 
is greater than can be accounted for by the blood 
discharged. When the menopause is attained sud- 
denly, the retention of such albuminoid substances 
must act toxically. Hence the resulting clinical fact 
that sudden cessation of the menses is, in the major- 
ity of cases, attended with pronounced symptoms of 
discomfort, and it is in these cases that untoward 
results are most likely. 

James Oliver believes that the catamenial flow 
eliminates from the body substances whose presence 
in the blood would exert a deleterious influence on 
the animal economy. 

The Prominent Symptoms of the Menopause. — 
Christopher Martin holds that the symptoms of the 
change of life are produced largely by a condition 
of instability and increased excitability of certain 
other cerebrospinal centers directly brought about 
by failure of the menstrual center, and adds : " It 
is probable that the ovaries, like the liver and thy- 
roid gland, modify the blood circulating through 

them, and add to the blood some peculiar product 
16 



242 The Menopause. - 

of their metabolism. It may be that some of the 
climacteric symptoms are due to the loss of this 
substance from the system." 

Arthur Johnstone's theory of the symptoms of 
the menopause is that the lining membrane of the 
uterus atrophies and becomes old cicatricial tissue, 
and sinks into quiet decay. The nervous system 
begins to readjust itself; but no longer having free 
outlet through the soft, lymphoid tissues of the 
uterus, the wave pressure meets with resistance and 
a choppy sea results. Vertigos, bilious attacks, and 
so forth are nothing more than reflex waves. The 
weakest organ of the individual is the one that 
generally suffers. And that the kidneys, which all 
along have borne the brunt of life, should now show 
positive signs of disease is natural. 

The etiology and pathology of the menopause lie 
in the sympathetic nervous system. And it is by 
the breaking up of the harmony of previous pro- 
cesses that nervous disturbances are produced. 

After the cessation of the flow, over 8% of 
women suffer from " flashes " ; this symptom is 
caused by irritation of the heart and vasomotor 
centers. The blood-vessels of the head and neck 
seem to be most affected, yet the skin of the whole 
body shares in the disturbance. Besides the vaso- 
motor and heat center being disturbed, the sweat 
center is irritated. The flushes and flashes are fol- 



The Menopause. 243 

lowed by various degrees of sweating, which varies 
from a slight moisture to great drops. 

Nervous irritability is a prominent symptom in 
8% of women at the time of the menopause. Most 
of the pain arises around the stomach; that is, the 
solar plexus. Digestive disturbances are very com- 
mon at this time; they may be in the shape of 
fermentation, diarrhea, or constipation, accompanied 
by congestion of the liver. 

Tilt holds the very plausible view that the too 
strong reaction of the sexual organs on the central 
ganglia of the sympathetic nervous system is their 
principal cause of disease. Puberty, menstruation, 
pregnancy, lactation, or the menopause almost al- 
ways entail some derangement of this system which 
is sometimes sufficiently severe to lead to insanity 
and suicide. Debility underlies all affections of the 
sympathetic nervous system, in the same way as 
nervous irritability underlies all cerebral diseases. 
Sometimes there is an overpowering sense of ex- 
haustion pervading the whole system. 

Forms of climacteric insanity are delirium, mania, 
hypochondriasis, melancholia, irresponsible im- 
pulses, and the perversion of moral instincts. 

" If the reproductive apparatus does not act on 

the brain by the instrumentality of the circulating 

organs of the blood, it must do so by means of the 

nerves. The genital apparatus is richly endowed 

13 



244 The Menopause. ~ 

with nerves from the sympathetic system, and I 
have shown how frequently evident signs of dis- 
turbance in these centers coincided or alternated 
with headaches, nervousness, hysteria, and epilepsy. 
What wonder, then, if the same powerful influence 
of the sexual organs, through the instrumentality 
of the sympathetic system, should at times produce 
a permanent derangement of the mental and moral 
faculties. I am thus led to look on the sympathetic 
nervous center as a source of vital power producing 
reflex morbid phenomena, in accordance with vari- 
able cerebral predisposition " (Tilt). 

Another very frequent symptom of the meno- 
pause is distress in the region of the heart, with 
palpitation and shortness of breath. It may be 
caused by the condition of the blood, whether it 
be impoverished — anemia — or too rich in red 
globules; by reflex irritation of the pneumogastric 
or sympathetic nerves; by overexertion; or by 
alcoholism. It may also be due to general debility ; 
the woman resists fatigue less easily, and she ex- 
periences a general malaise. To the palpitations 
are rapidly added faintness and shortness of breath. 
The sleep is troubled with distress in the region of 
the heart. It is said that women in whom the 
menopause occurs early are more liable to tachycar- 
dia than those who menstruate later in life; and 
that it occurs with especial frequency when the 



The Menopause. 245 

menopause has been prematurely induced by surgi- 
cal operation or by disease. It is believed that this 
functional heart trouble is caused by the increased 
connective-tissue fibers of the sexual organs acting 
in some unknown way on the terminal fibers of the 
sympathetic; and it is not infrequently due to the 
formation of scar tissue at the seat of a cervical 
laceration, and has often been promptly and per- 
manently relieved by removing the cicatricial tissue 
and suturing the wound. The cause acts by pro- 
ducing a transitory paralysis of the inhibitory fibers 
of the pneumogastric nerve. 

Pathologic Conditions of the Menopause. — Per- 
haps the most alarming symptom of the menopause 
is hemorrhage. It may be due to general or local 
causes. Among the general causes are diseases of 
the heart, lungs, spleen, and kidneys. Local causes 
of hemorrhage are: inflammation of the lining 
membrane of the uterus, chronic pelvic inflamma- 
tions, faulty uterine positions, erosions and ulcera- 
tions of the mouth of the uterus, fibroid tumors, 
and cancer. All competent observers agree that 
cancer in women is much commoner from forty 
to fifty years than at any other age. 

Hemorrhages occupy the foremost place among 
the pathologic phenomena of the genital tract dur- 
ing the menopause. Hemorrhage has been attrib- 
uted in many instances to the senile rigidity and 



246 The Menopause/ 

friability of the uterine vessels, which are not in 
a condition to offer sufficient resistance to the blood- 
pressure which is brought to bear on their walls; 
there is also softening and relaxation of the uterine 
tissue. Additional causes are found in the circula- 
tory disturbances in the pelvic organs, whereby the 
outflow of blood from the pelvic vessels is hindered 
and a chronic congestion in the uterine vessels is 
produced. It has also been attributed to early and 
profuse menstruation, frequent and difficult labors, 
frequent abortions, and excess in drinking. 

The third and last variety includes those cases 
which may be referred to some disease of the pelvic 
organs themselves. Anatomic changes may lead up 
to pathologic conditions. A chief feature charac- 
teristic of uterine disease is malnutrition from atro- 
phy — a sudden curtailing of the blood-supply from 
the degeneration of the genital-nerve apparatus and 
consequent impaired vitality of tissue from defect- 
ive nourishment. The anatomic changes in the 
glands and substance of the uterus also favor the 
irritation, and the development of new growths, 
which may be malignant or benign — as cancers, 
fibroid growths, and so forth. 

Hemorrhage at the Menopause a Significant 
Symptom of Cancer. — Not only should any exces- 
sive and prolonged bleeding at the time of the meno- 
pause be a source of great anxiety to the woman, 



The Menopause. 247 

but even the irregular appearance of a slight show 
of blood just sufficient to keep the clothing stained, 
or a slight bleeding following coition; since all of 
these are symptoms of very great gravity, and de- 
mand an immediate local examination and appropri- 
ate treatment. 

The widespread belief among the laity that hem- 
orrhage at the time of the menopause is a normal 
condition, and that if left alone it will stop in the 
course of a few years, is most erroneous and fatal. 
On this altar of ignorance thousands of women 
sacrifice their lives every year. The case-book of 
any gynecologist will testify to the truth of this 
statement. The following three cases will serve to 
illustrate different types of hemorrhage in cancer 
patients, in no one of which did the patient even 
suspect that she was suffering from anything more 
serious than the " vagaries of the menopause. " 

Case I. — Woman aged seventy years; came on 
account of incontinence of urine, which had been 
troublesome for two years. The menopause oc- 
curred at fifty. She stated that three or four years 
previous to her visit, she had had a return of the 
flow of blood, perhaps twice in the first year, and 
that during the past year there had been a flow 
every month — about the same that there used to 
be. This she took to be a return of the menstrual 
period. She said, further, that there was a constant 



248 The Menopause." 

bleeding — enough to necessitate the wearing of a 
napkin — and an occasional severe hemorrhage; that 
she could not take long walks or drives because 
of the excessive flow which followed. 

The case was one of cancer of the uterus which 
had spreal to all the pelvic viscera ; and in addition 
to this, the patient's general condition was such 
that any operation was out of the question. Yet 
the patient had never thought of the possibility of 
any uterine trouble sufficiently serious to make a 
local examination necessary. It was only the loss 
of control over the bladder that drove her to seek 
a physician's advice. 

Case II. — Woman aged fifty-three years came to 
consult me because of pain, hemorrhage, and loss 
of weight. There had never been any cessation of 
the menstrual period. She said that she began to 
have irregular hemorrhages three years previously, 
and that they were constantly becoming more fre- 
quent and more alarming, and that, in addition 
to this, there was a constant discharge of blood, 
which necessitated her wearing a napkin all the 
time. She also stated that for the preceding six 
months the pain had been so severe that she had 
not had one solid night's sleep, and that in that 
time she had lost forty pounds in weight. 

This patient was in the very last stages of cancer 
of the uterus, and all that could be done for her 



The Menopause. 249 

was to make her comfortable. She had given birth 
to one child which caused a deep tear of the neck 
of the womb ; and it is probable that this neglected 
tear was the primary cause of the cancer, which 
began in the neck of the womb. 

Case III. — Woman aged forty-five years; mar- 
ried, but had never had any children. She said 
that the periods were normal as to duration and 
amount, but that for the past two years they had 
been two days ahead of time, and that for the past 
four months she had been having just enough ir- 
regular bleeding between the periods to keep her 
clothing stained. 

On examination a diagnosis of cancer of the 
uterus was made. The pathological examination 
proved this to be a most malignant type of cancer 
of the neck of the womb. The entire uterus and 
appendages were at once removed. And although 
the patient made an excellent recovery from the 
operation, she succumbed to the disease one year 
after the operation was performed. 

These cases have been cited at length because 
they are all typical and because of the variety of 
symptoms and the great difference of age. Only in 
one of the cases was there any very severe pain, and 
it was really the pain, which had become unendur- 
able, which caused the patient to seek relief. 

It is the concensus of opinion of the medical 



250 The Menopause. 

profession that cancer of the uterus is one of the 
common causes of death among women; that the 
cancer rate of mortality has increased during the 
last four decades ; that it is most common near 
the time of the menopause; and that there is a 
direct causal relation between cancer of the neck 
of the womb and the traumatisms which occur dur- 
ing childbirth. 

The symptoms of cancer of the uterus are hem- 
orrhage, a more or less offensive discharge, and 
pain. The quantity of blood may vary from a 
slight amount which occasionally stains the clothing 
to a profuse hemorrhage. In the married, bleeding 
following coition is always a suggestive symptom. 
During the menopause any irregular or profuse 
bleeding should excite suspicion. After the cessa- 
tion of the menopause any bleeding whatsoever, 
whether slight or profuse, should always be re- 
garded as a danger signal which demands an imme- 
diate and thorough local examination. The same 
is true of any offensive vaginal discharge. Pain is 
frequently so late a symptom that to wait for its 
appearance means that the favorable time to perform 
an operation has passed by. Emaciation is also 
a symptom of advanced disease. 

Cancer is chiefly a disease of the climacteric; 
when there is a diminished power on the part of 
the tissues to resist adverse influence. It affects 



The Menopause. 251 

the debilitated and overworked, but it is also found 
in the well nourished and in the comparatively 
young. 

Cancer always begins as a local disease, and when 
it occurs in the uterus, it is easily accessible and 
eradicable in its earliest stages; that is, if the dis- 
ease is discovered in its incipiency, an operation 
will remove all the diseased tissue. If, on the con- 
trary, the disease is left to nature, the growth 
spreads out into the surrounding viscera like the 
roots of a tree in the earth, and the cancer may be 
literally said to eat into the tissues which it invades. 
At the same time the germs of the disease begin 
to be carried all through the body, and the entire 
constitution is affected. 

Prophylaxis, or the Prevention of Cancer. — All 
pelvic inflammations should be promptly treated, 
and not allowed to become chronic. Leucorrhea is 
a symptom of inflammation, the true cause of which 
can be determined only by local examination. 
Women who have given birth to children — and this 
is more especially necessary as they near the age of 
forty years — should be carefully examined for 
tears of the neck of the womb. If these tears are 
extensive they should be repaired, as it is certain 
that malignant growths frequently do follow local 
injuries and traumatisms. 

Any irregular or profuse bleeding demands an 



252 The Menopause. 

immediate investigation by means of a local exam- 
ination. 

A stormy, irregular, or delayed menopause should 
excite in the woman a suspicion of some abnormal 
condition. 

The importance of women being carefully watched 
by gynecologists at this period of their lives cannot 
be too emphatically stated, for upon the early recog- 
nition of cancer depends the only hope of radical 
cure of the disease. It is estimated that at the 
present time not less than 95 per cent, of all cases 
of cancer of the uterus come under the observation 
of the profession at a stage of the disease when all 
prospect of permanent relief is out of the question. 

It is a deplorable state of affairs that women, not 
knowing what a normal climacteric is, attribute all 
hemorrhages, no matter how severe, to the change 
of life. Therefore, regarding the hemorrhage as 
a necessary evil, they fail to consult a specialist 
until the favorable time for eradicating the disease 
by means of an operation has passed. And what- 
ever knowledge science may bring in the future as 
to the cure of cancer, at present it is a fact univers- 
ally agreed upon that early operation, while the 
cancer is still local, is the only radical cure for the 
disease. 

Pruritus Vulvae. Perhaps one of the most an- 
noying and obstinate symptoms of the menopause 



The Menopause. 253 

is pruritus vulvae. This is sometimes caused by 
sugar in the urine ; there is a congestion of the liver 
which results in sugar being thrown into the sys- 
tem and this is eliminated by the kidneys. It is 
quite possible that this is due to the altered circu- 
latory conditions of the menopause. 

Kidney Disease. — The last pathologic condition 
which we will mention is kidney disease. Le Gen- 
dre believes that the menopause exerts a deleterious 
effect on the kidneys, whether this be a congestion, 
followed by a diminution in the quantity of urine, 
or a sort of auto-intoxication due to the retention 
of a poison in the system that has been prevented 
from leaving by the ordinary path. 

Armstrong says that in almost all cases at the 
time of the menopause the amount of urine passed 
is below normal, the specific gravity is increased, 
and that the urine contains urates and almost al- 
ways uric acid in excess. Further, that the func- 
tions of digestion and assimilation and the various 
metabolic changes are so largely under the control 
of the nerve-centers that nothing seems more likely 
than that so great a disturbance of that system as 
takes place at the menopause should cause secondary 
derangements of these most important functions. 
That being so, the blood becomes loaded with waste 
products, and the usual symptoms follow — gout 
and so forth. 



254 The Menopause. 

It has been a grave question in the mind of the 
medical profession whether the dangers that cer- 
tainly do attend the menopause are natural or ac- 
quired; that is, could these dangers be averted by 
any precautions or hygienic measures on the part 
of women, or are these dangers a necessary accom- 
paniment of this period of life? 

Tilt has reached the conclusion that : " The best 
way to avoid the dangers of this critical time is to 
meet its approach with a healthy constitution. A 
marked want of strength prevents the regular suc- 
cession of the vital phenomena by which all critical 
periods are carried on. And as the change of life 
is marked by debility, when this is grafted on con- 
stitutional weakness, loss of power will be of long 
duration. All complaints remain chronic because 
there is not stamina enough to carry them through 
their stages." 

Causes of Suffering at Menopause. — Dusourd, 
whose practice lay in an agricultural district in the 
south of France, as well as Tilt, believes that peas- 
ant women suffer little at this time. Their health 
is generally good when the menopause comes on 
and they are little liable to nervous disorders. The 
poor of large towns suffer much at this epoch — 
the necessity of working hard, the anxieties of pov- 
erty and their unhygienic surroundings. But by 
a fortunate compensation the necessity for working 



The Menopause. 255 

hard prevents or cures the nervous affections which 
so often assail the rich at this period. 

Tilt's cases showed that women who suffered 
much at the menopause had previously suffered at 
puberty and at the menstrual periods. And among 
thirty-nine cases where there was no suffering at 
the menopause, there was the same immunity from 
suffering at puberty and at the menstrual epochs. 

Tilt's statistics were, or course, taken from Eng- 
lish women. In forty-four cases of my own, all 
women past the menopause, the average age of the 
first menstruation was fourteen years and four 
months; and the average age of the actual cessa- 
tion of the menstrual flow was forty-eight years 
and five and two-thirds months. Subtracting from 
this the average age of the first menstruation, we 
have as the mean age of menstrual life thirty-four 
years one and two-thirds months ; that is, the aver- 
age duration of the menstrual function was from 
two to four years longer than that usually given. 

A further investigation in order to ascertain any 
possible relation between the age of marriage and 
the number of pregnancies and the sufferings of the 
menopause elicited the following statistics: The 
average age of marriage was twenty-five year? and 
ten months. Of the four women who were married 
after thirty-eight years, all were sterile ; among the 
remaining there was an average of slightly above 



256 The Menopause. 

three children each. Forty per cent, of all these 
cases had one or more miscarriages. Nine had 
habitually suffered from severe dysmenorrhea, eleven 
had slight dysmenorrhea, and twenty-two had never 
felt the slightest inconvenience. 

In a list of fifty-two cases, eight were added to 
the list already given, all of whom had passed the 
menopause. Five were perfectly healthy and had 
never suffered the slightest inconvenience. Of these, 
one was single and only one had one miscarriage. 
Ten had suffered at the time of the menopause from 
slight malaise, but not sufficiently to call in a medi- 
cal attendant. Thirty-seven were more or less seri- 
ously ill; thirty of these needed local as well as 
constitutional treatment, and seven constitutional 
treatment only. 

The prominent symptoms of the climacteric were 
as follows: Marked debility, 24; intense nervous- 
ness, 31; nervous prostration, 9; melancholia, 10; 
headache, 14; neuralgia, 6; hysteria, 7; irritable 
heart, 11; tachycardia, 8; insomnia, 19; indiges- 
tion, 32; constipation, 28; diarrhea, 3; leucorrhea, 
38; rheumatism, 2 1 ; gout, 1 ; Bright's disease, 12; 
hemorrhage, 6 ; alcoholism, 2 ; corpulency, 2. 

As a result of the study of these cases, the most 
striking feature was the relation of miscarriages 
to the sufferings and ill health at the time of the 
menopause. Of the nineteen women who had mis- 



The Menopause. 257 

carriages, only one did not suffer in some way at 
the time of the menopause. Four suffered only 
slightly, and fourteen suffered extremely, not only 
during the menopause, but in the post-climacteric 
period as well. And the next most striking feature 
was that the prominent symptoms of the menopause 
are preeminently reflex or the functional diseases 
of the nervous system. 

Tilt believes that single women suffer less than 
other women at the time of the menopause. He 
further writes : " As at puberty, from the ignor- 
ance in which it is still thought right to leave young 
women, so at the change of life, women often suf- 
fer from ignorance of what may occur, or from 
exaggerated notions of the perils which await them. 
It would be well if they were made to understand 
that if in tolerable health, provided that they will 
conform to judicious rules, they have only blessings 
to expect from the change of life. Most unfortu- 
nately, the individual not cognizant of the invisible 
changes going on in the economy does not adapt 
the mode of life to the new conditions of the organ- 
ism, and the weakened and lessened amount of the 
digestive fluids is unable to master the large quan- 
tities of food. The absorbents refuse to take more 
than is needed to repair the tissues. The atrophy- 
ing muscles of the digestive tube, unable to hurry 
on the mixed products of indigestion ; fermentation ; 
17 



258 The Menopause. 

and micro-organisms inciting fermentations and 
elaborating toxic alkaloids, poison and disorder the 
functions of life. Man's outdoor life enables him 
to escape many of these evils. 

" Woman's enervating mode of life, the continued 
introspection, coupled with the peculiar changes in 
the nutrition of the body at this time, render the 
nervous system peculiarly impressionable and liable 
to the manifold forms of diseases. * The woman 
is told that she must be calm and patient, and in 
time the tomb-builder will alleviate all her suffer- 
ings.' This critical period may be dangerous to those 
who are always ailing, for habitiual sufferers at 
the menstrual periods, and for those affected with 
uterine diseases. If, on the first indication of the 
change of life, women who are in fair health care- 
fully followed a regimen and pursued a line of life 
in harmony with the physiologic processes on which 
this change depends, disease would be prevented. 
But as the change concerns a natural function, it is 
left to nature ; no additional precautions are taken, 
and advice is sought only when the mischief is 
done." 

It is not wise to marry during this period. On 
the first appearance of the irregularities of the men- 
opause the amount of food and stimulants to which 
women have been accustomed should be curtailed 
rather than augmented. The system requires sup- 



The Menopause. 259 

porting by medicine and regimen — as, baths, men- 
tal and moral hygiene, and occupation — rather than 
stimulating by spirits. 

We have seen that, in accordance with the pleth- 
ric theory, which prevailed until 1835, an< ^ w ^h 
the nerve theory, which is based on the latest ana- 
tomic and physiologic researches, menstruation is 
a physiologic process to get rid of effete material, 
and is therefore an excretion. 

At the end of perhaps thirty years, by a con- 
servative process of nature, the child-bearing period 
ceases and the organism is readjusted to the end 
that the woman's vitality may all be conserved for 
her own individual life. 

Each metamorphic or developmental period of 
life — dentition, puberty, and the menopause — 
throws a special strain on the nervous system, and 
the recent studies of the sympathetic nervous sys- 
tem at the time of the menopause show that very 
extensive anatomic changes occur at this time. That 
being the case, the woman must lead such a life as 
will insure her having on hand a large reserve force 
necessary to meet these heavy demands. Tilt's ob- 
servations show that women who have experienced 
no suffering at puberty or at the menstrual periods 
do not suffer at the menopause. It is therefore 
evident that the time to begin this preparation is in 
childhood. 



260 The Menopause. 

That single women suffer less than married 
women would suggest that excessive coitus and the 
occurrence of abortions, frequent child-bearing, and 
lesions as the result of pregnancies, many of which 
lesions could have been prevented or cured by the 
timely aid of the physician, are the combined sources 
of much of the suffering at the time of the meno- 
pause. 

That the most frequent and serious disturbances 
are those of the nervous system, and that from their 
mode of life and habits of introspection the rich 
suffer more from these ailments than the poor, must 
cause serious consideration of the physiologic neces- 
sity for a definite occupation for the daughters as 
well as for the sons of the rich. 

The frequency with which Bright's disease is 
found at the time of the menopause is dependent not 
so much on the local physiologic changes which are 
taking place as on the time of life. Loomis says 
that it was not until life-insurance examinations 
became so common that the frequency with which 
kidney disease existed in persons who believed them- 
selves well was even imagined. And as a result of 
his observations in these cases, and of a large num- 
ber of autopsies conducted at the Bellevue, he stated 
that it was his belief that 90% of men and women 
over forty years of age suffer from some form of 
Bright's disease. That being the case, it would 



The Menopause. 261 

seem that after this period of life at least as much 
attention should be directed to the kidneys as to 
the teeth, and that a semi-annual examination of 
the urine should be made. 

Although the. menopause is a physiologic occur- 
rence, yet, owing to the many pathologic changes 
which are liable to take place at this time, the woman 
should be as carefully watched during the meno- 
pause by the gynecologist as the pregnant woman 
now is by the obstetrician. If the same care were 
taken, in the majority of cases, the dangers attend- 
ing the menopause would be avoided, and the woman 
would be prepared to enjoy a healthy and useful 
post-climacteric period of life. 



CHAPTER XVII. 

HYGIENE OF THE MENOPAUSE. 

Diet; Constipation; Stimulants ; the Kidneys; the 
Skin; Turkish Baths; Massage; Exercise; Pro- 
fuse Menstruation; Hemorrhage; Mental Thera- 
peutics. 

" 'Tis the breathing time of day." 

— "Hamlet." 

Hygiene of the Menopause. — The changes which 
occur in all the organs of the body at the time of 
the menopause are retrograde, and therefore just 
the opposite of those which occur at the time of 
puberty. This fact should be borne in mind in the 
matter of alimentation. All that is now needed is 
to make the repair equal to the waste. 

Diet. — Unless the woman is taking a great deal 
of active exercise, it is better to diminish the amount 
of meat eaten, and to increase the vegetable food 
and take more fluids. Unless the effect of the meat 
eaten is counterbalanced by active outdoor exercise, 
it produces an excess of waste matter, which accu- 
mulates and causes biliousness, and sometimes rheu- 
matism and gout. A vegetable diet is less taxing 
to the excretory organs than an animal diet. 

262 



Hygiene of the Menopause. 263 

Indigestion is at this time of life apt to appear 
in the form of fermentation, which may assume the 
gastric or intestinal type. The chief causes of the 
formation of gases are the lessened peristaltic action 
of the intestines, the increased tendency to conges- 
tion of the liver and to obstinate constipation. 

All dishes rich in sugar, as cake, candy, pre- 
serves, and jelly, should be indulged in with mod- 
eration; or where there is a tendency to fermenta- 
tive indigestion, they should be wholly avoided. 

All dishes known to be difficult of digestion, as 
hot breads, pastry, cheese, fried dishes, and rich 
salads, should be cut off the menu, since these read- 
ily overtax an already weakened digestive system. 

If there is a hereditary tendency to rheumatism 
or gout, the disease is most apt to take on an active 
form at this time. In either case the manifesta- 
tion of the disease indicates an excess of uric acid 
in the system, and a diet becomes a necessity. 
Pickles, all highly spiced articles of food, and vine- 
gar must be omitted from the bill of fare. The 
vinegar may be replaced in salad-dressings by lemon 
juice. Tomatoes, rhubarb, strawberries and grape- 
fruit are contra-indicated; also all articles of food 
rich in sugar. 

In chronic cases animal food cannot, as a rule, 
be excluded from the dietary, but must be limited 
in quantity. Fish, eggs, and fowl may be eaten, 



264 The Menopause. 

also a moderate amount of lean meat in the form 
of beef, lamb, and mutton. Milk may be indulged 
in freely. The diet should consist principally of 
easily digested fresh green vegetables. The amount 
of tea and coffee should be limited. All malt liquors, 
sweet wines, and champagne must be absolutely 
prohibited. 

Constipation. — A daily free evacuation of the 
bowels is essential to good health. Where consti- 
pation exists, and the woman is full-blooded, with 
a tendency to a rush of blood to the head, saline 
laxatives are indicated. But if the woman is con- 
stipated and anemic, cascara sagrada is a better 
laxative; while cod-liver oil acts as a laxative and 
at the same time improves the quality of the blood. 

Stimulants. — Women resort to alcoholic stimu- 
lants as an analgesic to relieve pain, whether physi- 
cal or mental; as a narcotic to produce sleep; and 
as a spur to a failing appetite or bodily powers. 

The majority of women patients say that they 
first used alcohol in the shape of whisky, brandy 
or gin to relieve pain at the time of the menstrual 
period. The pain that is caused at this time by 
a chilling of the body would be as effectually re- 
lieved by drinking a cup of hot tea; while if the 
pain is intense and constant, recurring every month, 
it is doubtless caused by some local inflammation, 
and the use of alcohol only veils the real trouble, 



Hygiene of the Menopause. 265 

and the woman loses valuable time by not con- 
sulting* a physician at once. 

As to the use of alcohol to blunt the nervous 
sensibility due to mental suffering, it is the testi- 
mony of the entire medical profession that this 
is the greatest cause of inebriety or drunkenness 
among women of all classes of society. 

Sleeplessness generally arises from some well- 
defined physical cause — very frequently from in- 
action of the liver — and the proper remedial agents 
should be used to remove the cause. 

While at first the use of alcoholic beverages in- 
creases the appetite, as the amount taken is in- 
creased, distaste for food is created, the system 
languishes under an insufficient food-supply, and 
the original aim of increasing the appetite is de- 
feated. 

As to taking stimulants to do more work than 
one could otherwise accomplish, it is by means of 
stimulants that woman can accomplish her physio- 
logical ruin more quickly than is possible in any 
other way. And the early symptoms of chronic 
alcoholism show themselves in the form of neu- 
ralgia, insomnia, palpitation of the heart, and mus- 
cular tremors. 

The Kidneys. — On account of the prevalence of 
some form of Bright's disease after forty years of 
life, the kidneys should be carefully watched at this 



266 The Menopause. 

time. And in order to keep them in good condi- 
tion they must be well flushed with water every- 
day. Three pints of urine should be excreted daily, 
and three pints of water as such must be taken into 
the system daily. The urine should be examined 
by the physician every six months. In this way 
kidney disease is often discovered in its incipiency, 
which otherwise might run into a serious form of 
Bright's disease. 

The Skin. — It must be remembered that the skin 
is one of the excretory organs of the body, and the 
pores should be kept well open by the various forms 
of baths. 

The Turkish bath or some modification of it 
will often be found to be particularly useful. Mas- 
sage with alcohol after the bath lessens the tendency 
to take cold. For a woman who is anemic or run 
down, it is well to follow the Turkish with the 
Roman bath, which is an inunction with almond 
oil or cocoa-butter. A much more thorough mas- 
sage is given with the Roman bath than with the 
" alcohol rub." It is often necessary to modify the 
Turkish bath by omitting the steam-room and short- 
ening the time spent in the hot dry air. In ordinary 
cases the time spent in the hot dry-room should be 
only that necessary for producing a free perspira- 
tion. This time varies in different individuals from 
ten to twenty minutes. No woman should go to 



Hygiene of the Menopause. 267 

a Turkish bath without first consulting her physi- 
cian, since if the woman has a weak heart, the bath 
may be the source of positive danger. Compara- 
tively few women are strong enough to take the 
cold plunge. 

Massage. — Massage, well given by a skilful mas- 
seuse twice a week, will greatly tone up the nervous 
and circulatory systems. Women who are very 
stout and who have sluggish livers with obstinate 
constipation will find massage particularly bene- 
ficial. 

Exercise. — Daily exercise in the open air is ab- 
solutely essential to every woman's good health. 
The minimum amount of outdoor exercise com- 
patible with health is an hour's walk, at the rate 
of three miles an hour. If the woman has never 
taken any exercise, she must begin with a very 
short walk and stop on the first sign of fatigue. 
Gradually increase the distance and the speed until 
the three miles is reached. 

Profuse Menstruation. — If the menstrual flow is 
unusually profuse or lasts beyond the regular time, 
the woman should stay quietly in bed until the 
flow ceases. All exercise increases the flow. 

The flow now becomes less in quantity, and the 
periods more infrequent than formerly. Hemor- 
rhage must always be regarded as a danger-signal 
the significance of which can scarcely be overesti- 



268 The Menopause. 

mated. To immediately consult a specialist on the 
appearance of any irregularities of the flow would, 
in the opinion of the most eminent gynecologists 
of the day, be the means of saving thousands of 
women's lives every year. 

Mental Therapeutics. — It is particularly necessary 
at this time of life that the mind should be pleas- 
antly occupied. Her children have passed the age 
when they need her constant supervision, and the 
mother must take some relaxation from her home 
cares, in the form of social diversions, amusements, 
outdoor life, and change of scene. Any mental oc- 
cupation that will take the woman out of herself 
is the best possible safeguard against a state of 
introspection which conjures up a host of evil fan- 
tasies, and which is the first step in the downward 
road to a fixed and permanent melancholia. 

"Hang sorrow, care will kill a cat; 
And therefore let 's be merry." 



CHAPTER XVIII. 

HINTS FOR HOME TREATMENT. 

Indigestion; Constipation; Enemas; Diarrhea; 
Vaginal Douche; Baths; Headache; Fainting; 
Hemorrhage. 

"Woman is woman's natural ally." 

— Euripides. 

Indigestion. — The chief causes of indigestion are : 
eating rapidly, eating at irregular hours, eating in- 
digestible foods, constipation, and lack of exercise. 
No one who values her good health will allow her- 
self to be hurried through a meal, nor will she allow 
the perplexities of life to be thrust upon her at the 
table for solution. The first requisite for the diges- 
tion of foods is that they should be well masticated, 
so that the digestive fluids may act on the finely 
divided particles to the greatest possible advantage. 
And while digestion is going on all mental labor 
should be held in abeyance, in order to avoid draw- 
ing the blood away from the stomach to the brain. 
Furthermore, it is a well-known fact that digestion 
is best performed when the meals are served at 
regular hours. 

269 



270 The Menopause." 

Constipation leads to the formation of gases in 
'the intestines, to fermentation, and to the absorp- 
tion of toxic materials by the blood. 

Through lack of exercise, the appetite fails, the 
liver becomes torpid, and the muscular and nervous 
systems lose their tone. 

The exercise which the housekeeper gets in go- 
ing around her house is not sufficient. Daily ex- 
ercise in the open air is essential to health; as this 
is to supplement the indoor exercise, the amount 
taken will vary in proportion to the former. For 
teachers or those who have a sedentary occupation 
an hour's active exercise in the open air — a three- 
mile walk — should be supplemented by active gym- 
nastic exercise. 

For people in good health, a mixed diet — that 
is to say, a diet consisting of meat, vegetables, and 
fruit — is the best. If the individual is not well, 
then the diet must be adapted to meet the needs 
of that particular case. 

Hot breads, all articles of food fried in fats, 
salads, and pastry are difficult to digest. Tea is 
very constipating, and when taken in excessive 
quantities renders the individual nervous. An ex- 
cess of coffee leads to congestion of the liver. 

Where indigestion exists, the simplest and most 
•sensible remedies are to regulate the diet, and avoid 
eating between meals. By drinking a glass of water 



Hints for Home Treatment. 271 

as hot as it can be sipped one hour before each 
meal, the mucus is washed out of the stomach, the 
stomach is empty on coming to the table, and in 
the best possible condition for the gastric juice to 
act on the food-stuffs. 

Constipation. — Constipation is the rule with the 
average American woman ; the causes are their cor- 
sets, the tight bands of their clothing, lack of ex- 
ercise, and the fact that they drink too little water 
and too much tea. The most rational means to 
overcome it is to drink more water; at least three 
pints a day should be taken, in addition to soups, 
tea and coffee, and so forth; the water must be 
taken into the system as such. Then attention must 
be given to the diet ; plenty of fruit should be eaten, 
vegetables, and coarse bread. 

Regularity in this, as in all other habits of life, 
is most essential, and the individual should go to 
the toilet at the same hour every day, even if there 
is no inclination to have a bowel movement, and 
thus the habit will be established; the most con- 
venient time is directly after breakfast. 

Medical Treatment. — But if all these means have 
failed, medicines must be resorted to. Cold water 
is a better laxative than hot; to a glassful of cold 
water add from one teaspoonful to one tablespoonful 
of the effervescing granules of the phosphate of 
soda, and take this the first thing on rising in the 



27 2 The Menopause. 

morning. This preparation of soda is particularly 
useful because it acts slightly on the liver. Other 
laxatives are : a seidlitz powder dissolved in a glass 
of cold water on rising; a wineglass or more of 
Hunyadi Janos, also taken on rising. Any of these 
may be taken with safety by pregnant women. For 
children the simplest laxative is one teaspoonful 
of Husband's milk of magnesia, to be taken in one 
glass of water on rising. 

In the past few years the mineral oils have be- 
come very popular for the treatment of constipation. 
They are clear, transparent, flavorless, and water- 
like in appearance; the advantage claimed for them 
is that they lubricate the intestinal canal without 
being absorbed in the body. There are a number of 
excellent preparations on the market; the average 
dose for adults is one tablespoonful before retiring. 

Enemas. — Perhaps one of the most common meth- 
ods used by the laity for the relief of constipation 
is the rectal injection, or enema. Enemas habitually 
given to unload the bowels are productive of much 
harm by overdistending the rectum, so that in time 
the rectum fails to react to the normal stimulus — 
namely, the presence of the feces — as it otherwise 
would. But by some means or other the bowels 
must be well moved once every twenty-four hours. 
And it is much better to use an enema than to go 
to bed without a bowel movement. If the woman 
is going around, so that she can give the enema 



Hints for Home Treatment. 273 

to herself, the most effective way to take it is in 
the knee-chest position or an approximation to this. 
Either a fountain or bulb syringe may be used for 
this purpose; a quart of water at a temperature 
of no° F. should be prepared by making it into 
a suds with castile soap, or one tablespoonful of 
glycerin may be added to one pint of water. The 
nozle to be used is the smallest one that comes with 
the syringe, the so-called infant's nozle ; this is quite 
large enough, and its insertion is not nearly so 
painful as the larger ones; the nozle must be well 
greased with vaselin. When everything is ready, 
the patient gets down on her knees with the shoul- 
ders near the floor, having first loosened all of her 
bands and taken off her corsets; the nozle is in- 
troduced as far as it will go into the rectum, and 
if a bulb syringe is used the water must be very 
gradually squeezed into the rectum, otherwise it 
will not retain so much; or if the fountain syringe 
is used, it must not be hung too high. So soon as 
the patient feels that she has taken all that she 
can retain, she should lie down on the left side, and 
retain the water as long as possible, as it is thus 
rendered more effective. An enema so taken will 
be very much more effective than one taken in 
the ordinary manner of sitting on the toilet. In 
the method just described more water can be used 

and it will be longer retained; it can be felt to go 
18 



274 The Menopause. 

up along the course of the large bowel, and it will 
often be found very effective when the ordinary 
enema fails. This enema will often be found to 
be a very valuable aid in curing an obstinate chronic 
diarrhea, which is kept up by particles of feces re- 
maining in the folds of the large intestine. If the 
patient is confined to bed, she should lie on the 
left side, with a heavy towel folded under her to 
prevent the bed from becoming wet; when the 
nurse withdraws the nozle she should make pres- 
sure on the anus with the towel, to help the patient 
to retain the water as long as possible. But should 
the patient have gone so long without a bowel move- 
ment that all these means fail, it will be necessary 
to precede the water enema with one of oil ; or still 
more effective is the following combination : take 
one teaspoonful of the spirits of turpentine, the yolk 
of one egg, and two tablespoon fuls of olive oil, and 
beat well together, and add to these one pint of 
water at a temperature of no° F. Constipation, 
however, of so obstinate a character as this de- 
mands a physician's attention. 

Diarrhea. — A diarrhea may be acute or chronic; 
the treatment is essentially different. For an acute 
attack accompanied by frequent stools and severe 
abdominal pain the first thing to do is to go to 
bed. If there is nausea, drink a glass of water as 
hot as can be taken, at once; for the diet, a glass 
of scalded milk, not boiled but just allowed to come 



Hints for Home Treatment. 275 

to the boiling-point, every two hours ; and nothing 
else should be taken until the diarrhea is well in 
check. If the pain is severe, a spice plaster over 
the abdomen will be found to be very comforting. 
It is made as follows: take of powdered allspice, 
cinnamon, cloves, and ginger each two tablespoon- 
fuls, and two teaspoonfuls of cayenne pepper; mix 
well together in a bowl; then quilt in a piece of 
flannel large enough to cover the abdomen; when 
ready for use, dip in hot whisky and apply as hot 
as the patient can bear; cover over with a large 
napkin, as the plaster produces a deep stain which 
does not wash out; keep on as long as necessary. 
If the rest in bed and the milk diet kept up for 
twenty-four hours do not suffice to cure the diar- 
rhea, it is not wise to take any risks, but send for 
your doctor at once. Or if there should be any 
blood in the stools, do not wait for anything, but 
send for the doctor without delay. 

For a chronic diarrhea an enema given in the 
knee-chest position, as already described, will often 
be found a most efficient remedy. In diarrheas the 
use of fruits and vegetables should be avoided ; the 
best diet after the milk is bread well toasted through, 
toast-water, soft-boiled eggs, beefsteak, oyster stew, 
and clam broth. 

Vaginal Douche. — To be of service except for 
mere cleansing purposes the douche must be taken 
in the horizontal position, either on a couch or, if 



276 The Menopause. 

it is not cold, on the floor. Of course, this position 
necessitates the use of a douche-pan. The douche- 
pan is best of agate-ware, oblong in shape, and with 
a broad strip which comes under the nates. On 
lying down to take the douche the nates must come 
down well over the pan and the clothing must be 
pushed well up to prevent the water from seeping 
up the back. To make the woman more comfortable 
there should be a pillow under the head, and she 
must have a shawl or some light woolen material 
to throw over her while taking the douche to pre- 
vent chilling; thus doing more harm than good. 
There are two forms of syringes on the market : 
the bag or fountain syringe, which is hung up suf- 
ficiently high — about three feet above the patient 
— to cause the water to flow ; and the bulb syringe, 
in which the bulb has to be constantly squeezed by 
the hand, which is tiresome to many women, but 
this is a much more convenient form to have in 
traveling. During pregnancy the fountain syringe 
only should be used, and it should be hung as low 
as will enable the water to flow. For a woman 
who has never taken douches it is well to begin 
with a temperature of no F., gradually increasing 
the temperature to 118 or 120 ; this is as high as 
the woman should attempt to go, for a higher tem- 
perature would burn her, leaving the vulva so sensi- 
tive that she would only be able to take cool douches 
for a long time after this; a bath thermometer 



Hints for Home Treatment. 277 

should be used in all cases to test the temperature, 
so that the woman knows exactly what she is doing. 

In cases of inflammation of the uterus or its 
adnexa four quarts of water should be used, and 
the douche should be taken in the horizontal posi- 
tion. The water thus acts as a hot poultice about 
the uterus, and the woman will find on rising that 
some water flows out from the vagina. Ordinarily 
plain hot water is all that is necessary to use, but 
where the discharge is acrid and scalding, the plain 
hot-water douche should be followed by a warm 
douche containing one teaspoonful of borax to a 
pint of water. The best time for taking a douche 
is at night just before retiring; there is also less 
danger of taking cold when the douche is taken at 
this time. 

The scalding sensations at the vulva may be due 
to the acidity of the urine, in which case it will be 
increased just after urination; or it may be due 
to an acrid discharge from the vagina. A little 
observation on the part of the patient will enable 
her to distinguish which is the real cause. If there 
is any trouble with the urine, it should be carefully 
examined at once, as some congestion or inflam- 
mation of the kidneys is not infrequently present, 
which if attended to might be cured, and which if 
allowed to run on unattended to, may develop into 
a serious .form of Bright's disease. 

The genitals should be washed with soap and 



278 The Menopause. 

water night and morning. Women who do not 
suffer from leuchorrhea need not take a vaginal 
douche more than once a week; after the menstrual 
flow the vaginal injection is advised to remove the 
detritus of the flow. 

Baths. — The most ordinary forms of baths used 
may be classified under sponge-, shower-, sitz-, and 
tub-baths. The sponge-bath as ordinarily taken is 
of service for cleansing purposes, and if the water 
be cold it tones up the system to some extent, and 
is so a preventive against taking cold. The effect 
of this bath will be found to be vastly more beneficial 
if salt is added to the bath in the proportion of 
a pint of salt to a gallon of water; either sea-salt 
may be used or the ordinary coarse salt. It is most 
advantageously taken sitting in a bath or hat-tub, 
so that the entire surface of the body will be wet 
at the same time, and the water can be allowed to 
run down the back and over the chest. It is well 
to begin these baths at a temperature of 80 ° F. and 
to gradually decrease this until the bath is taken 
at 70 °, which is about the temperature of running 
water, and the bath should be kept up at this. For 
most people the best time to take the bath is just 
before retiring; this bath is not only very strength- 
ening, but also is excellent in cases of insomnia 
and nervousness. 

Shower-baths. — These may be taken after a hot 
bath, or taken alone after violent muscular exercise. 



Hints for Home Treatment. 279 

The body should be quickly scrubbed off and the 
shower should be warm at the beginning and gradu- 
ally allowed to become cold, stooping over so as to 
get the full force of the shower on the spine and 
over the region of the stomach and heart They 
will be found to be most refreshing after great mus- 
cular fatigue, and, when taken after the hot tub- 
bath, greatly lessen the susceptibility of the indi- 
vidual to taking cold. 

Sitz-baths. — These are given for their local effect 
in cases of inflammation ; whether this inflammation 
be of the kidneys, bladder, or of the uterus and its 
adnexa. A sitz-tub is necessary to properly take 
this form of bath. The water should be used as 
hot as is comfortable to the patient, from 105 to 
no° F., hot water being added as the first cools off; 
a pint of salt should be added to the gallon of 
water, and the patient should remain in this from 
five to eight minutes. A blanket should be wrapped 
about the patient so that she will be thrown into 
a perspiration ; it is almost needless to say that the 
only time for taking this bath is just before retiring, 
and that this bath does make the woman more sus- 
ceptible to taking cold, so that it is necessary to 
wear an abdominal woolen bandage day and night. 
Tub-baths. — The tub-bath ought not, as a rule, 
be taken more than twice a week, unless the cold 
plunge is used, which may be taken every day. If 
the tub-bath is taken hot, the woman should remain 






280 The Menopause. 

in it not much longer than is necessary to scrub off 
with a flesh-brush; this bath should be followed 
either with a cold shower-bath, or the water in the 
tub be gradually allowed to cool off until it is down 
to 70 F. 

Headaches. — Headaches, aside from those of 
acute illness, may be roughly divided into three 
classes : first, those which are due to indigestion ; 
second, neuralgic headaches; and, third, those due 
to pelvic inflammations. The headaches due to in- 
digestion are usually located over the eyes and all 
over the forehead; they are more or less constant 
and are accompanied by other symptoms of indiges- 
tion, and very often by constipation. The feces are 
allowed to remain in the bowels overlong, the toxic 
matters are taken up by the blood, and headaches 
and vertigo result. 

Neuralgic headaches are of an entirely different 
character; the pains are here of a lancinating char- 
acter, and are not confined to any one region of 
the head. As a rule, they are accompanied by neu- 
ralgic pains in other parts of the body. Neuralgia 
generally means a rundown state of the system from 
overwork, worry, or malaria, and tonics and cod- 
liver oil are indicated. 

A constant dull pain on the top of the head or 
in the back of the neck generally indicates some 
uterine inflammation, and can only be cured by re- 
moving the cause. In any case it is very evident 



Hints for Home Treatment. 281 

that taking the various " headache powders " with 
which the market is flooded will never cure the 
woman of her headaches; and many of these pow- 
ders are very dangerous, especially where the heart 
is weak, as most of them are heart-depressants. 

Fainting. — Fainting may be due to a weak heart, 
to heart disease, or to sudden shock, as on receiving 
a bad piece of news ; during pregnancy the close air 
of a room may cause a woman to faint. The first 
thing to be done is to lay the woman down on the 
floor or bed with nothing under her head; loosen 
all her clothes about the neck and waist, and throw 
the windows open so that she will get plenty of 
fresh air. If she is able to drink, give her one tea- 
spoonful of aromatic spirits of ammonia in four 
tablespoon fuls of cold water. If the feet are cold, 
place hot-water bottles to them to improve the cir- 
culation. And if at the end of fifteen minutes she 
does not show signs of decided improvement, give 
her two tablespoon fuls of whisky in an equal quan- 
tity of hot water. In the meantime the physician 
will have been summoned. These attacks of faint- 
ing often occur in a crowded ball-room, and are due 
to tight lacing and the poor ventilation of the room. 

Hemorrhage. — A profuse hemorrhage is the most 
alarming as well as the most dangerous thing which 
can befall a woman, and the very nearest doctor 
should be summoned until the family physician can 



282 The Menopauser 

be gotten there. The woman should be made to 
lie down wherever she may happen to be, her clothes 
loosened, the windows thrown open, so that she will 
not only have plenty of fresh air, but that the air 
shall be cool. If the blood is coming from the 
mouth, give her pieces of ice to hold in it; if she 
coughs up the blood, it would be well to put a bag 
of ice-cold water or cloths wrung out of ice-water 
on the chest. If the woman is suffering from a 
uterine hemorrhage, have her take at once a hot 
vaginal douche, from 118 to 120 F., and have 
the foot of the bed raised. The head should always 
be kept low. 

Women hold their health in their own hands to 
a far greater extent than they have ever dreamed 
of; and if the majority of women suffer, it is very 
often their own fault, either because they have dis- 
regarded nearly every law of health, or have al- 
lowed trivial ailments to go on until they were 
almost incurable. 



" The broad mountain-top, with its sunlight and free air, is possible 
to all of us, if we choose to struggle on and reach it." 

—Phillips Brooks. 



GLOSSARY. 



Abortion. The expulsion of the 
fetus before the end of the third 
lunar month. 

Afferent Nerves. Those nerves 
which convey the impressions 
to the nerve -centers. 

After-pains. The pains which 
follow labor and which are 
caused by the contractions of 
the uterus. 

Amenorrhea. Absence of the 
menstrual flow. 

Anemia. The so-called thin- 
ness of the blood, due to a 
deficiency of red blood- corpus- 
cles. 

Antisepsis. The use of chemi- 
cal substances which have the 
power of destroying germs. 

Anus. The external circular out- 
let of the rectum or distal part 
of the large intestine. 

Appendages, Uterine. The Fal- 
lopian tubes, the ligaments of 
the uterus, and the ovaries. 

Atrophy. A progressive diminu- 
tion in the bulk of an organ or 
tissue. 

Automatic. Involuntary, me- 
chanical. 

Bulbi Vestibuli. A plexus of 
veins on each side of the vesti- 
bule. 



Capillaries. The terminal and 
very finest branches of the blood- 
vessels. 

Catamenial Flow. See Men- 
struation. 

Cellular Tissue. A loose, trans- 
parent tissue which surrounds 
the muscles and organs of the 
body. 

Cerebrum. The upper and larger 
portion of the brain. 

Chlorosis. Anemia of young 
women about the time of pub- 
erty. 

Climacteric. See Menopause. 

Clitoris. A small, elongated, 
erectile organ situated at the 
upper part of the vulva. 

Cohabitation. See Coitus. 

Coition. See Coitus. 

Coitus. Syn., coition, copula- 
tion, cohabitation, sexual con- 
gress, sexual intercourse. The 
carnal union of the sexes. 

Colostrum. A thin albuminous 
fluid which appears in the breasts 
at the fourth month of preg- 
nane)''. 

Conception, or impregnation, is 
the union of the germ and sperm 
cell which results in a new being. 

Confinement. Childbed, the ex- 
pulsion of the child from the 
womb. 

283 



284 



Glossary. 



Congestion. The abnormal ac- 
cumulation of blood in a part. 

Constipation. Costiveness ; a 
state in which there is not a 
free daily evacuation of the 
bowels, or where the evacua- 
tions are hard or expelled with 
difficulty. 

Continence. Abstinence from or 
moderation in sexual indulgence. 

Copulation. See Coitus. 

Cord, Umbilical. The cord 
which connects the fetus with 
the mother. Through the blood- 
vessels contained in this cord 
the child receives nourish 
ment. 

Corpuscle. A very small par- 
ticle. 

Decidua. A membranous sac 
formed in the uterus during 
gestation, and thrown off after 
parturition. 

Defecation. The act by which 
the contents of the bowel are 
expelled from the body. 

Dehiscence. The splitting open 
of an organ. 

Dentition. The cutting of the 
teeth. 

Dysmenorrhea. Painful and 
difficult menstruation. 

Dystocia. A difficult labor. 

Embryo. The name applied to 
the very earliest stages of the 
child in utero; that is, up to 
about the time of quickening. 

Endometrium. The lining mem- 
brane of the uterus. 



Epithelium. A layer of minute 
cells which forms the covering 
of many membranes. 

Erection. The state of a part 
which, having been soft, be- 
comes rigid and elevated by the 
accumulation of blood within 
its tissues. 

Fallopian Tubes. Two very 
small tubes extending from the 
upper angles of the uterus to 
the ovaries and serving to con- 
vey the ova from the ovaries to 
the uterus. 

Feces. Stools; the normal dis- 
charge from the bowels. 

Fetus. The child in utero from 
the time of quickening to that 
of birth. 

Fomentations. The application 
of cloths which have previously 
been dipped in hot water. 

Function. An action of an organ 
which could be performed only 
by that organ, and which is 
necessary to the well-being of 
the individual. 

Generative Organs. Syn., geni- 
tal, reproductive, sexual ; those 
organs in the male and female 
by means of which a new being 
is created. 

Genital. See Generative. 

Gestation. See Pregnancy. 

Gonorrhea. A highly contagious 
venereal disease, characterized 
by an inflammatory discharge of 
mucus from the urethra and pre- 
puce in the male, and from the 



Glossary. 



28s 



urethra and the vagina in the 
female. 
Graafian Follicles. Minute 
ovarian vesicles which contain 
the ova. 

Hemorrhoids. Piles or tumors 
at or within the anus, and con- 
sisting of enlarged veins. . 

Hymen. The semilunar fold 
situated at the outer orifice of 
the vagina in the virgin. 

Hypertrophy. The increased 
activity of a part which leads to 
an increase in its bulk. 

Hypochondriasis. Morbid feel- 
ings concerning the health and 
simulating disease. 

Impregnation. See Conception. 
Infectious. See Contagious. 

Katabolic Nerves are those 
nerves which stimulate the 
breaking down of tissue. 

Labia Majora. Two thick folds 

of skin which extend backward 

from the mons veneris. 
Labia Minora. Nymphae; two 

very delicate folds of skin which 

are inside of and protected by 

the labia majora. 
Labor. See Parturition. 
Lactation. The secretion of 

milk; nursing, suckling the 

child. 
Lactiferous Ducts. The milk 

ducts. 
Leucorrhea. Whites ; a whitish 



or yellowish discharge from the 
vagina. 

Lochia. A discharge which fol- 
lows labor and which lasts for 
about two weeks. 

Lying-in. The period which fol- 
lows childbed. 

Lymphatics. The vessels in 
which the lymph is carried. 

Mammae. The mammary glands ; 
the breasts. 

Marital Relations. See Coitus. 

Massage. A systematic knead- 
ing of the muscles. 

Meatus Urinarius. The exter- 
nal orifice of the urethra. 

Meconium. The first discharge 
from the infant's bowel after 
birth, and which had collected 
in the intestines during the preg- 
nancy. 

Medulla. The base of the brain 
at its junction with the spinal cord. 

Menopause. Climacteric, change 
of life, the time of the natural 
cessation of the monthly sick- 
ness. 

Menorrhagia. An excessive men- 
strual flow. 

Menstruation. Menstrual period, 
menstrual flow, menses, monthly 
sickness, the monthly discharge 
of blood from the uterus, which, 
with certain exceptions, recurs 
monthly from about the age of 
thirteen to forty-six years. 

Metabolism. Transformation 
changes. 

Metamorphoses. Changes of 
shape or structure. 



286 



Glossary. 



Metrorrhagia. A flow of blood 
between the menstrual periods. 

Micturition. The act of passing 
water. 

Miscarriage. The expulsion of 
the fetus between the twelfth 
and twenty-eighth weeks. 

Molecular. Belonging to the 
molecules, or the minutest por- 
tion of anything. 

Mons Veneris. The uppermost 
part of the vulva, which is a 
fatty cushion covered with hair. 

Nerve-center. A nerve station 
from which orders are trans- 
mitted and where orders are re- 
ceived. 

Nubile. Puberty, that period of 
life in which young people of 
both sexes are capable of pro- 
creating children. 

Nymphse. See Labia minora. 

Ovaries. Two small ovoid bodies, 
one on each side of the uterus, 
in which the ova are formed. 

Oviduct. See Fallopian tube. 

Ovulation. The formation of the 
ova in the ovary, and the dis- 
charge of the same. 

Ovule. See Ovum. 

Ovum. Germ cell, a small, round 
vesicle situated in the ovaries, 
and which, when fecundated, 
constitutes the rudiments of the 
embryo. 

Parturition. Labor, delivery, 
child-birth, the expulsion of the 
child from the womb. 



Pathologic. Relating to the dis- 
eased condition of the body. 

Pelvis. The bony cavity situ- 
ated at the lower end of the 
spinal column and supported by 
the thighs. 

Periodicity. The recurrence of 
physiologic phenomena at regu- 
lar intervals. 

Periphery. The circumference 
of an organ. 

Peristaltic Action. An alter- 
nate contraction, making small, 
and enlargement of the bowel ; 
it is by this means that foods, etc., 
are forced along its passage. 

Peritoneum. A serous mem- 
brane which lines the abdominal 
cavity, and wholly or in part 
envelopes the organs contained 
in it; it also partly covers the 
organs contained in the pelvic 
cavity. 

Phenomena. Remarkable ap- 
pearances. 

Physical. Pertaining to the body. 

Placenta. After-birth, a soft, 
spongy, vascular body adherent 
to the uterus, and which is con- 
nected with the embryo through 
the umbilical cord. 

Plethora. A condition marked 
by a superabundance of blood. 

Postpartum Hemorrhage. 
Hemorrhage following labor. 

Pregnant. Enceinte, gravid; the 
state of a woman who is with 
child. 

Premature Labor. The expul- 
sion of the fetus between the 
end of the twenty-eighth week 



Glossary. 



287 



and the time that labor ought to 
have occurred. 

Propagation. The spreading or 
extension of a thing. 

Pruritus Vulvae. An intense 
itching of the privates, or vulvae. 

Psychic. Pertaining or belong- 
ing to the mind. 

Puberty. Sexual maturity; nu- 
bility; that period of life in 
which young people of both 
sexes are capable of procreating 
children. 

Pubes or Pubis. The lowest 
and middle part of the pelvis in 
its anterior surface. 

Puerperium. The lying-in after 
child-birth. 

Quickening. The sensation ex- 
perienced by the mother as the 
result of active fetal movements 
in the womb. 

Rectum. The lower extremity 
of the large intestine. 

Reflex. The reflection of an im- 
pulse from a nerve-center which 
has been received from else- 
where by that center. 

Reproduction. See Generative. 

Respiration. Breathing. 

Rugae. Wrinkles. 

Rut. The copulation of animals. 

Septicemia, Puerperal. Child- 
bed fever. 

Sexual. That which relates to 
sex. See Generative. 

Smegma. A cheesy substance 



which may collect about the 

vulvae. 
Spermatozoa. The essential male 

fertilizing elements. 
Sympathetic Nervous System. 

Presides over involuntary acts ; 

as digestion, breathing, etc. 
Syphilis. A venereal disease 

which is highly contagious by 

coition, contact with the lips, 

etc. 

Tachycardia. Distress in the 

region of the heart, with palpi- 
tation and shortness of breath. 

Umbilicus. Navel. 

Urea. The most important of 
the solid constituents of the 
urine. 

Ureters. The ducts leading from 
the kidneys to the bladder. 

Urethra. The excretory duct 
from the bladder for the escape 
of the urine. 

Urination. The act of passing 
water. 

Uterosacral Ligaments. Liga- 
ments which pass from the 
uterus to the sacrum, and assist 
in holding the uterus in position. 

Uterus. Womb ; the hollow, pear- 
shaped pelvic organ which is 
destined to retain the child from 
the moment of its conception 
until the time of its expulsion at 
birth. 

Utricular Glands. Glands of 
the uterus. 

Vagina. The canal which con- 



288 



Glossary. 



nects the female internal and ex- 
ternal organs of generation. 

Vascular. Pertaining to the 
blood-vessels. 

Vasomotor Nervous System. 
Comprises the brain, spinal 
cord, and the nerves given off 
from the cord : this system pre- 
sides over voluntary acts, that is, 
those acts which are under the 
control of the will. 



Vestibule. A smooth cavity that 
exists in the female between the 
perineum and the nymphse. 

Viscera. The contents of the 
large cavities of the body. 

Vulva. The external genitals, 
private parts, the female exter- 
nal organs of generation. 

Vulvitis. Inflammation of the 
vulva. 



INDEX 



PAGE 

Abortion, crime of 156 

Abuses of sex in men 51 

Adolescence of boys and sex instruction 59 

After-pains 200 

Alcoholism a contraindication to parenthood 29 

Amenorrhea in 

causes of 112 

Application of eugenic principles 44 

Artificial feeding 217 

Athletics, value of 63 

Baby's outfit 185 

Baths 278 

salt sponge- 278 

shower- 278 

sitz- 279 

tub- 279 

Turkish- 266 

Bed, confinement- 188 

shall husband and wife occupy the same 130 

Biology of sex 48 

Bladder 91 

Body and mind, correlation of 18 

Cancer of uterus 246 

prevention 251 

symptoms 250 

Coitus, excessive 139 

effects of 140 

local diseases caused by 141 

manifestations of 142 

Conception, nature of 158 

prevention of 152 

Confinement 180 

baby's outfit 185 

bed for 188 

preparation of 188 

choice of room for 182 

dress of mother for 182 

engagement of the nurse ......... r , 181 

19 289 



290 Index. 

PAGE 

Confinement, outfit for mother 182 

preparations for 180 

room 182 

sterilizing articles for 186 

Constipation 82, 264, 271 

in infants 230 

mineral oils for 272 

treatment of 271 

Continence, aids to 143 

Contraindications to parenthood 27 

Control of the sex impulse 64 

Conventions as safeguards to maidenhood 72 

Correlation of mind and body 18 

Corsets, injury done to young girls by 76 

maternity 170 

Cretinism a contraindication to parenthood 29 

Crib, infant's 212 

Desk positions 82 

correct 83 

faulty 83 

Diarrhea, acute 274 

chronic 275 

treatment of 275 

Diet at menopause 262 

at puberty 80 

Douche, vaginal 275 

Duration of nursing ' 215 

Dysmenorrhea no 

Early marriages 38 

Education , 17 

age for going to school 23 

as controlling factor in physical life of woman 17 

effect of study of scientific branches 24 

Huxley's definition of 17 

industrial 24 

literature on sex 66 

sex 45 

Efficiency, sexual 34 

Enemas 272 

Engagement, proper length of time for 125 

Eugenic marriages 41, 42 

Eugenics 26 

and love 43 

medical examinations 40 

Exercise 85, 267 

Fainting 281 

Fallopian tubes • 93 



Index. 291 

PAGE 

Feeble-mindedness a contraindication to parenthood 29 

Feeding of infants 213 

artificial 217 

First period of sex instruction 54 

Formula for artificial feeding 218 

Frequency of pelvic disorders in young women 115 

Friendships during maidenhood 73 

Galton's law of inheritance 32 

Generative organs, female, anatomy of 89 

physiology of 96 

Genetics 26 

Girdles 79 

Gonorrheal infection 52, 124 

Growth and reproduction 37 

Headaches 280 

Health and sex hygiene _ 45 

Heart disease a contraindication to parenthood 30 

Hemophilia a contraindication to parenthood 29 

Hemorrhage at menopause 246 

treatment of 282 

Heredity 31, 168 

Home life 75 

Husband, what constitutes a suitable 119 

Husbands, do reformed profligates make good 124 

Hymen 90 

condition of, as proof of virginity 90 

Importance of sex knowledge 45 

Indigestion, treatment of 269 

Infant 206 

age of beginning to walk 227 

artificial feeding of 217 

bath for 207 

capacity of stomach of 223 

characteristics of healthy 224 

cleansing of 210 

constipation of 230 

crib for 212 

cry, nature of 229 

dressing of the cord 206 

falling off of cord 207 

feeding of 213 

first discharge of 210 

fresh air for 223 

length of time for feeding 215 

mental development of 225 

muscular action 226 

nursing-bottle 222 

rubber nipples for 222 



292 Index. 

PAGE 

Infant, outfit for 185 

pulse of 229 

rectal injections for 230 

respiration of 228 

stools of 229 

teething 232 

temperature 216 

the newborn 206 

toilet of 207 

urination 231 

ventilation of room for 212 

vomiting 231 

Walker-Gordon laboratory milk for 221 

weight of 226 

Infidelity in women 156 

Inheritance, Galton's law of 32 

Kidney disease 253 

at menopause 253, 265 

Knowledge, importance of sound 47 

Labor, average length of time of 192 

nourishment during 194 

pains 192 

process of 191 

signs of approaching 187 

symptoms of actual 188 

toilet of patient at beginning of 193 

after 195 

Lactation 202 

deficiency of milk 202 

Leucorrhea 113 

Limitation of offspring 38 

Literature on sex education 66 

Lochia 201 

Love 65 

Herbert Spencer's definition of 117 

Lying-in period, the 196 

diet during 198 

duration of 201 

evacuation of bowels during 200 

lochia 201 

management of 196 

room for 196 

sponge-baths during 198 

urination 199 

visitors 198 

vulvar dressings 197 

Maidenhood, safeguarding 71 

Marriage 127 

and parenthood 65 



Index. 293 

PAGE 

Marriage at time of menopause 258 

best age for t 20 

consummation of 131 

contraindications to 121 

early 38 

essentials for happy 1 20 

eugenic 42 

health certificate for 125 

marital relations . 132 

times they should be suspended . . 136, 177 

Married life, ethics of 127 

shall husband and wife occupy the same bed? .... 130 

Marry, shall cousins 121 

right time of the year to 126 

Massage 267 

Maternity 158 

corsets 1 70 

Meconium 210 

Menopause 234 

B right's disease, frequency of, at 260 

causes of suffering at 254 

duration of 235 

general phenomena of 236 

pathologic conditions of 245 

prominent symptoms of 241 

Menorrhagia, causes of no 

definition of 109 

Menstrual cycle, stages of 101 

flow, average duration of 102 

character of 103 

premonitory symptoms of 105 

function, average duration of 234 

wave 103 

Menstruation 97 

anomalies of 109 

definition of 105 

etiology of 97 

exercise during 107 

first onset of 70 

hygiene of 106 

painful 1 10 

profuse 109 

scanty 112 

treatment for taking cold during 107 

Metrorrhagia, causes of 109 

definition of 109 

Mind and body, correlation of 18 

Mineral oils for constipation 272 

Miscarriage, causes of 1 78 

prevention of . . . ". 179 



294 Index. 



PAGE 

Nature, the emotional 21 

Need of sex education 48 

Nipples, care of 204 

Nurse for confinement 181 

Nursing 203 

contraindications to 203 

duration of 215 

frequency of 203 

nutrition 202 

overdistention of breasts 205 

position of mother during 204 

Nutrition 79 

Offspring, limitation of 152 

Ovaries 94 

Ovulation 96 

present view of 103 

relation of, to menstruation 103 

Parenthood and marriage 65 

contraindications to 27 

Pelvic disorders in young women, frequency of 115 

Periods of life and sex instruction 54 

Physical changes at sexual maturity 50 

Postpubertal stage and sex instruction 61 

Pregnancy 158 

abdomen, changes in 163 

average duration of 159 

baths during 174 

bladder, functional disturbances of 163 

symptoms during 173 

constipation 172 

denned 159 

diet 171 

dress 170 

duration 159 

exercise 175 

hemorrhoids 175 

hygiene of 169 

leucorrhea 173 

mammary changes at 162 

marital relations 177 

mental occupation 176 

signs of 161 

sleep during 177 

Prepubertal stage and sex instruction 57 

Present view of ovulation 103 

Profligates, reformed, do they make good husbands? 124 

Pruritus vulvae _ 114 

Pubertal state and sex instruction 58 






Index. 295 

PAGE 

Puberty 67 

age of 69 

hygiene of 75 

physical changes at 69 

psychic changes at 70 

Quickening 164 

Reproduction and growth 37 

Reproductive factors in the male 34 

in the female 35 

Running 86 

Safeguarding maidenhood 71 

Scales and thermometer 215 

School, age for going to 23 

life. . . . 82 

Sex, abuses of, in men 51 

biology of 48 

determination of, at will 165 

education 45 

literature on 66 

need of 48 

periods of life for 54 

hygiene and health 45 

impulse, control of 64 

Sexual development 67 

efficiency 34 

element, influence of the male on the female organism.... 167 

excitability 142 

treatment of 142 

incompatibility 146 

instinct in women 138 

maturity, physical changes at 50 

Shoes 79 

Single standard of morals 54 

Social diseases 52 

Spinal curvatures 84 

Standard of morals, single 54 

Sterility 144 

causes of 144 

Stimulants 264 

Syphilis 53 

Teething in infants 232 

Therapeutics, mental 268 

Thermometer and scales 215 

Toilet during labor 193 

Transmission of characteristics 36 

Tuberculosis and parenthood 30 



296 Index. ' , 

PAGE 

Underwear 79 

Uterine nerve-supply 99 

Uterus _ 92 

function of 101 

respiratory movements of 93 

Vagina 91 

Vaginal douche 275 

secretion 149 

Value of sound knowledge 47 

Venereal diseases 52 

Ventilation 84 

Walking 85 

Water 81 

Waters, bag of 192 

Wedding-day, selection of 126 

Wedding-journey 127 

Weight of infant 216 

Wet-nurse, selection of ... . 217 

Womb, position of child in 192 

Women, infidelity in 156 



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